Further, India reflects starkly the reality that any country is several markets rather than one, with a wide variety of types of marketing — including those that may reach children.
Thus, limiting marketing via television, radio and mobile phones may address the types of sponsorship found in wealthy areas, but not those more common in poorer areas, including billboards or sponsorship of schools or sporting events. Overall, respondents felt that the disparity in importance of the health burden to most of the population, and in the legislative capacity, and indeed priority, to tackle what is seen as a minor issue, made the Set of Recommendations feel of less, if any, relevance to government.
Although at the time of the study, respondent reported that the Ministry planned to hire a number of people at headquarters and throughout the country who would be associated with this programme, until then non-communicable disease is dealt with on a national level with by a team of 4—5 people in a country with over one billion inhabitant. According to a Ministry representative, there is a wide disjuncture between the global context within which the Recommendations were formulated, and the specific national context; an expression of a more general limitation of global health diplomacy that no one policy will be fully applicable to all country contexts.
Is success in GHD measured at the time of endorsing Recommendations, or in their implementation?
Capacity building on health diplomacy: a training experience from Pakistan
Thus, a successful conclusion to international negotiations is part of a process, not the end, and a consideration of barriers and issues concerning national action is an important part of conducting and evaluating GHD. Within global health, there is examination of diplomacy involved in setting the stage for the development of agreements, and around the negotiation of agreements, but less reflecting the interface of this global level diplomacy and the national context within which these agreements are implemented.
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The Indian case presented here offers two lessons. This also includes recognising differences in national-level public health governance: what may be the responsibility of a ministry of health in one country may fall under a different ministry in another. Second, global norms and standards will never fully match the contexts within individual countries.
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Indeed, this is deliberately the case, as global agreements are usually written quite broadly, so they may be adopted. They are also often aspirational, representing a norm towards which countries can work, although the extent to which individual governments accept global norms depends on the national context. The potential for an agreement, particularly a non-binding one, to be applicable to Member States, is likely unrealistic.
That India did not take immediate steps to implement the Recommendations, nor to address marketing of food to children more widely, does not represent a failure of GHD. Rather, it reflects the reality of making global policy applicable to the individual contexts of WHO Member States, where the adoption of norms takes time and that the implementation of global health diplomacy outcomes must be conducted within national contexts and limitations.
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Moreover, despite the reliance on governments as key players, in many cases in which a government is not seen to be prioritising an issue, we see action from non-state actors in both implementation and monitoring of agreements. Methodologically it is also necessarily, but difficult, to focus on a non-case study. However, in studying the implementation of GHD is it just as important, although more challenging, to examine the cases in which implementation appears lacking.
Without this focus on the examples that demonstrate a lack of implementation, there is no means to understand whether a specific diplomatic activity has been worth the effort, and what factors have contributed to this, to inform further diplomatic developments for health. At present we are limited to reporting a snapshot in the process, but evaluation judgements are hard to make and will continue to be so for other cases unless progress is made in this methodological area. Lee K, Smith RD.
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Global Health Diplomacy: A Strategic Opportunity for India
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