Global Health Diplomacy Lacks Urgent Reform as Inequities and Power Imbalances Persist

Kabul, Afghanistan - The global health architecture stands at a precarious crossroads, plagued by underfunding, partisan politics, and safety risks for marginalized practitioners, highlighting the urgent need for reform in governance, funding, and evaluation of collaboration.

Global health diplomacy has become essential as global health problems like pandemics and climate-related illnesses are deeply interconnected and require collaborative efforts across governments, international bodies, academia, civil society, and the private sector. However, nationalist politics, budgetary disinvestment, and rising exclusionary ideologies have shrunk the global health space, creating a complex landscape that defies linear solutions.

The need for collaboration is amplified by theoretical models like complexity theory, which suggest that health outcomes are shaped by dynamic, non-linear relationships between political, environmental, and social systems. Despite attempts to establish community-based networks and cross-sector partnerships, their impact often remains mixed, with organizations operating within silos pointing to the urgent need for more integrated, inclusive frameworks.

The benefits of transdisciplinary collaboration, integrating insights from diverse fields to solve complex health challenges holistically, are undeniable but only come into effect when power dynamics and knowledge hierarchies are recognized. However, persistent North-South divides in health partnerships often reflect colonial legacies rather than equitable alliances, with funding asymmetry and implicit biases obstructing meaningful cooperation.

The Bergen Model of Collaborative Functioning (BMCF), which evaluates partnerships through four key dimensions—inputs, processes, outputs, and feedback loops, has found practical application in global health education, local governance, and multi-stakeholder responses to public health emergencies. However, its success hinges on a willingness to engage in honest assessment and ongoing adaptation, especially in fragile or politically sensitive environments.

Global health diplomacy is not merely about foreign policy or cross-border aid; it's 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.

Despite its potential, the field is plagued by power imbalances, with institutions like WHO promoting collaboration through cross-sector partnerships while studies have shown that knowledge transfer, leadership integration, and institutional bias limit their effectiveness. Moreover, governance of global health is riddled with paradoxes, prioritizing inclusive rhetoric over operational equity.

Health diplomacy must move beyond rhetorical equality to operational equity, acknowledging the exclusion experienced by Indigenous peoples, refugees, LGBTQ+ communities, and practitioners from low-income countries. It also requires a deeper look into South-South cooperation—a promising model for context-specific, community-driven diplomacy that can often be more agile, sustainable, and inclusive.

The measurement of collaboration in global health requires assessing governance structures, stakeholder inclusion, and power-sharing mechanisms. Researchers are using methods like equity-informed interpretive synthesis, collaborative governance frameworks, and social network analysis to understand how collaborations form and function.

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."