6 Bold Systems Thinking Strategies and Tools to Master Global Health Diplomacy and Leadership

Blip-Zip Executive Summary

Feeling stuck in your global health leadership role? Go global! Unleash the Power of Global Health Diplomacy (GHD) and Systems Thinking!  This article explores how GHD and systems thinking can help you navigate complex challenges & make a real difference in the world.

Blip-Zip Takeaways

• Master Complexity: Use systems thinking to see the bigger picture in global health.
• Embrace GHD: Build partnerships & tackle global health issues collaboratively.
• Elevate Your Career: Become a global health leader and make a lasting impact.

Key Words and Themes (#Hashtags)

#GlobalHealthLeadership, #SystemsThinking, #GlobalHealthDiplomacy, #PublicHealth, #HealthcareLeadership

Introduction To Mastering Systems Thinking for Global Health Diplomacy

The purpose of this article is to illustrate how a systems thinking approach, informed by Global Health Diplomacy (GHD) principles, can empower health leaders to navigate the complexities of global health. Understanding globalization, applying GHD, and aligning the National Security Strategy (NSS) fosters prosperity, health security, and national pride. Health issues have always been global and interdependent.¹  With internet-based business, cross-border agreements (e.g. pharmaceuticals) and ease of international travel (e.g. medical tourism), firms including health organizations with only domestic operations will be more rare.  Globally engaging in international business also requires diplomacy. 

Health leaders must become adept at navigating this interconnected system to achieve positive outcomes at the local, regional, and national levels. When the US responded to the earthquakes in Haiti, the supply of information, health professionals, and funds began at the local level. These actions opened national diplomatic doors and demonstrated our benevolence, especially to adversaries. For example, globalization, a key driver in this system, fosters economic opportunities and increases the spread of infectious diseases. Understanding these interrelationships is crucial for effective health leadership.

Understanding Globalization’s Impact

Global health is a complex adaptive system with interconnected components – social determinants of health, healthcare delivery systems, political landscapes, and environmental factors. The global economy and global health are two-way traveling companions. These components influence each other, creating feedback loops that can amplify or dampen health outcomes.

Actions in security, trade, conflict and crisis, environment, and human rights strongly affect whether the US can achieve national economic and global health security.²  The globalization and translation of biomedical research to cost-effective health interventions demand attention to being ethically, politically, and culturally sensitive.³

Today, more US health leaders engage in economic development such as nation-building, medical tourism, and partnering with worldwide and local health organizations for mutual benefit.  More US medicines are being produced in China and India, and more medical procedures are being acquired through international medical tourism. Increased immigration and open borders offer more opportunities for individuals seeking employment in the US. This challenges health leaders to deliver culturally sensitive health services or support.  Sharing research contributes to prosperity and security. 

While globalization has generated economic opportunity abroad, it requires more protection of the health and the safety of Americans in the US.  For example, the negative effects of globalization, such as terrorism and infectious diseases, have added increased complexities for today’s healthcare delivery system. Due to the nature of a globalizing economy, volume of travel, trade, and human interactions infectious disease exists anywhere in the world and can travel anywhere.3 Toronto suffered through a horrible epidemic of a disease brought by an unsuspecting elderly lady who attended a wedding in Hong Kong, contracted SARS, and then brought it back. 

Diseases such as West Nile Virus, malaria, and tuberculosis have come our way either by accident or on purpose.  For example, the deadly Ebola virus killed 14 people in western Uganda in July. Speculation caused many people to flee their homes. It is not inconceivable; an infected person could have gotten a plane and fled to the US.⁴ 

Further, GHD minded health leaders must understand how the effects of deteriorating health conditions create political risks in countries of strategic importance. For example, poor public health increases the likelihood of political instability, disenfranchises persons with inadequate social capital, limits economic growth, and exacerbates the human damage caused by social and economic dislocation⁵. 

Therefore, health leadership must understand how public health, medical, academic, and health industry institutions should play a role in advancing stability in an increasingly fragile world.  Investing or not investing in international health development ultimately diverts resources from the US economy.  By embracing globalization and developing a GHD mindset, health leaders will be in a better position to capitalize, respond, and contribute to the effects of globalization.

Global Health Diplomacy (GHD) Defined and Applicability

To start, GHD is constructive engagement for mutual benefit.  GHD is a form of international relations where health system capabilities are used to encourage positive relations, exchange specific benefits, or solve problems between nations.⁶  GHD can be traced to the International Sanitary Conference in 1851.  Attendees argued disease dissemination do not respect borders.  Acting alone will not reduce the risk of pandemics. Therefore, nations had to work together for mutual health security and economics.⁷

Former Secretary of Health and Human Services, Tommy Thompson, defined it as “To give people hope…while serving the interests of the United States,⁸” and later as “The winning of hearts and minds of people…by exporting medical care, expertise and personnel to help those who need it most.”⁹  The US Department of State categorized GHD as a subset of diplomatic efforts at the individual, regional, and national levels. It is defined as “reaching out across the world in the spirit of friendship, partnership, and respect to form partnerships resulting in a better life in meaningful ways.

Americans reach out because we believe in freedom and human rights, and, by doing so, we undermine ideological support for terrorism and nurture common interests. ¹⁰   Former President Bush’s definition is clearer, “Nations with free, healthy people will be sources of stability, not breeding grounds for hate and terror. By helping others, we help ourselves.” ¹¹

Applying GHD Supports US National Security Strategy (NSS)

Many think GHD is responding to a humanitarian crisis.  While true, it is more.  Health leaders at the local level serving diverse populations and employees, developing culturally aware health services and programs, and working with international organizations to build partnerships and capacity are applying the principles in GHD in the context of a globalized world.  GHD should be considered a way of seeking mutual interests of benevolence, economic value, and health security. 

At the regional and national level, GHD is the orchestration of actions to enhance US influence and security by providing care, building capacity and strengthening health infrastructure.¹²  To illustrate other forms of GHD, the following examples of how other nations, adversaries, and the US are applying GHD.  Each highlight a strategic (versus purely humanitarian) capability in support of the NSS to influence opinions. 

The more health leaders apply GHD to develop or provide resources for local and international health development, the stronger our nation becomes, ultimately leading to increased prosperity and security.  For example, this was evident in our response to the earthquakes in Haiti when coordination with government organizations deployed national response capabilities both within the U.S. government and with international partners for positive effect.5 Many US-based health organizations opened their doors to those in need or sent health professionals to help.  Health leaders who align, integrate, and provide resources support the US NSS. Many today see it as a calling and call to action.

 The US NSS identifies the task of building the infrastructure of democracy by building partnerships and partnership capacities with other governments.¹³  As a US example, military and civilian organizations provided support to the December 2004 tsunami and the October 2005 Pakistan earthquake.  This support was intended to enhance the legitimacy of the government and minimize instability by augmenting medical support of the local and international non-governmental organizations (NGOs) capabilities.¹⁴ 

As an ‘other nation’ example, Taiwan deliberately leverages its domestic medical capabilities and sends civilian medical teams to other nations with which it is or hopes to be allied.¹⁵  Hezbollah long considered an adversary, has a positive image among Lebanese Shia in part because of its ability to provide social services such as medical care and hospitals which the Lebanese government is not providing.¹⁶

GHD is translating words into action.  The NSS for Public Diplomacy discusses medical diplomacy as a means to communicate values far more effectively than words.17 As a US example, the Afghanistan and Iraq governments’ capacity to meet healthcare needs is improving but is not sufficient. The US has employed GHD in Afghanistan since 2002 and in Iraq since 2003¹⁸ by providing equipment, training, and advisors from civilian and military organizations as a means to create stability. 

Efforts have expanded to include medical civic-action programs and partnering with other worldwide health organizations.¹⁹ Cuba employs medical diplomacy to obtain recognition, resources, and other benefits.  Cuba defined medical diplomacy as “the collaboration between countries on health matters to improve relations.” ²⁰ Cuba has medical personnel in 70 countries, has provided no cost-flights to Cuba for free eye operations for as many as 750,000 people, and hosts nearly 10,000 foreign medical personnel for training.²¹ 

Hamas, another adversary have used health as a means to influence the population of the Gaza strip.²² Each applies GHD for mutual benefit.  US health leaders can do the same.

6 Bold GHD Strategies for Health Leaders

To be effective, health leaders must embrace GHD as a necessary skill and responsibility. GHD offers health leaders an opportunity to increase positive perceptions of the US, enhance the health of affected populations, and create mutual benefits for their organizations.²³  Health leaders need to assure organizations are structured to support the NSS for a swift response to crisis, create agreements, and actively engage winning the trust and confidence of international health partners.

Leveraging and integrating health services builds relationships for human growth, economic development, and cultural diversity. To begin, health leaders can employ GHD to assure cohesion with culturally aware programs, encourage volunteerism for international support, and make GHD an agenda item at annual association meetings.

For GHD to be effective at the national, regional, and local levels close coordination to develop policy, procedures and pre-event coordination, and training is required.²⁴  They must integrate, exercise, and evaluate their organization’s capabilities with other components of the health and economic system to produce improved health security, partnerships, and capacity.⁵  This includes supporting the international and national goals for eliminating threatening diseases and helping develop sustainable, coordinated health system capacity among partner organizations and governments to prevent morbidity and mortality. 

Health leaders can establish partnerships and exchange programs with international health counterparts to provide or train a cadre of GHD and medically trained personnel. Organizations with large groups of international patients can create customized health programs and they can invest in cultural awareness and sensitivity training to build cohesion.  Contributing to improving response to natural and manmade disasters, including complex humanitarian emergencies creates positive impressions by other nations and negates the same actions being used by our adversaries. Health leaders can ensure local capabilities and processes are exercised, and evaluated to assure the best health security. 

The United States has been a world leader in medical science and technology.  To maintain medical preeminence, the US must align its strategic and functional planning to ensure execution at the highest level. Finally, flexibility must be provided to physicians, nurses, and medical specialists including military reservists or those who are members of health related organizations who may be called upon to respond to work in difficult environments and situations. By working across borders, health leaders can address common challenges like infectious diseases and strengthen health systems worldwide.  To recap, Table 1 provides a recap of system thinking strategies and reinforces how health leaders must be systems stewards.

Table 1 Bold Systems Thinking Strategies

GHD Systems Thinking Strategies

Health Leaders as System Stewards

Causal Loop Diagrams: Visualize the feedback loops between GHD interventions and their intended outcomes (e.g., a program to strengthen local healthcare infrastructure can lead to reduced disease burden, attracting further investment). Mental Models: Challenge traditional assumptions about health delivery. Consider how cultural beliefs and economic disparities influence health outcomes. Boundary Critique: Recognize the limitations of national health systems and the importance of international partnerships.

Develop Cross-Sectoral Collaboration: Foster partnerships between healthcare institutions, NGOs, and government agencies to address social determinants of health. Invest in Long-Term Capacity Building: Support training programs for healthcare professionals in partner countries to create sustainable health systems. Embrace Cultural Sensitivity: Design culturally appropriate health interventions that respect local traditions and beliefs.

Conclusion

Health issues have always been global, interdependent, and diverse. Today, they are more rapid, opportunistic or threatening.  Global health leadership requires a nuanced understanding of complex systems and the power of collaboration. Health leaders, academics and practitioners must be more interested in ways to develop themselves as successful global health leaders. By embracing GHD principles and employing systems thinking tools, health leaders can navigate the interconnected world of global health, fostering prosperity, security, and a healthier world for all. Employing a strategy of collaboration with diplomatic, developmental, and integrative activities will open up more prosperous, economic, and secure doors.

However, GHD begins at home.  US health leaders who understand the value of GHD and opportunities will be more effective.  Health leaders who can effectively see the connection with their own organization and manage through this complex, changing, and often ambiguous global environment are critical to the success of their organizations and the nation’s health and economic security. By healing hearts and minds, we win them.  Global health leadership and GHD is a calling and call to action.

Are you ready to become a global health leader? Explore the resources below to get started on your journey!

Learn More

https://sheldr.com/master-5-questions-on-systems-thinking-4-better-health/

Deep Dive Questions

• How can you leverage systems thinking to identify the root causes of a global health challenge in your area of expertise?
• Imagine you’re leading a GHD initiative. How would you build trust and collaboration with international health partners?
• Considering the ethical, political, and cultural considerations outlined in the article, design a culturally sensitive health program for a specific global community.
• Research a successful GHD case study. How did it demonstrate the power of collaboration and address a global health challenge?
• How can you integrate GHD principles into your current leadership role to make a global health impact?

Professional Development and Learning Activities

• Participate in a GHD online course or workshop offered by a reputable organization like the Global Health Council.
• Volunteer for a global health organization to gain practical GHD experience.
• Partner with a colleague from a different healthcare discipline to co-create a presentation on a global health challenge, applying systems thinking principles.

References and Resources

• Global Health and the Future Role of the United States, https://www.ncbi.nlm.nih.gov/books/NBK458466/
• Global health diplomacy—reconstructing power and governance https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9113726/
• United Nations Office for Disaster Risk Reduction (UNDRR): https://www.undrr.org/: The UNDRR works to reduce disaster risk and vulnerability in communities around the world.
• The Global Health Leadership Network. https://corporatelearning.hms.harvard.edu/individuals/executive-education/global-health-care-leaders-program
• Systems Thinking for Global Health: How can systems thinking contribute to solving key challenges in Global Health? https://academic.oup.com/book/44641
• Diplomacy in a Globalizing World https://global.oup.com/academic/product/diplomacy-in-a-globalizing-world-9780190647988
• Systems Thinking for Global Health
• How can systems-thinking contribute to solving key challenges in Global Health? https://global.oup.com/academic/product/systems-thinking-for-global-health-9780198799498

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