Table Of ContentGlobal health, foreign policy, and agenda setting
processes : the European Union as a global health
actor
Citation for published version (APA):
Aluttis, C. A. (2016). Global health, foreign policy, and agenda setting processes : the European Union as
a global health actor. [Doctoral Thesis, Maastricht University]. Datawyse / Universitaire Pers Maastricht.
https://doi.org/10.26481/dis.20160217ca
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Published: 01/01/2016
DOI:
10.26481/dis.20160217ca
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Global health, foreign policy
and agenda setting processes
The European Union as a global health actor
Christoph Alexander Aluttis
© copyright Christoph Alexander Aluttis, Maastricht 2015
Print Datawyse | Universitaire Pers Maastricht
ISBN 978 94 6159 534 8
Global health, foreign policy and agenda
setting processes
The European Union as a global health actor
DISSERTATION
to obtain the degree of Doctor at Maastricht University,
on the authority of the Rector Magnificus Prof. dr. L.L.P. Soete,
in accordance with the decision of the Board of Deans,
to be defended in public
on Wednesday, 17 February 2016, at 12:00 hours
by
Christoph Alexander Aluttis
U
P
M
UNIVERSITAIRE
PERSMAASTRICHT
Supervisors
Prof. dr. H. Brand
Prof. dr. T. Krafft
Assessment committee
Prof. dr. J. Ritzen (chairman)
Prof. dr. I. Kickbusch, The Graduate Institute Geneva, Switzerland
Dr. A. Meershoek
Prof. dr. D. Townend
Dr. L. van Schaik, Netherlands Institute of International Relations ‘Clingendael’
CONTENTS
CHAPTER 1 General introduction and objective of this dissertation 1
CHAPTER 2 Global health in the European Union - a review from an agenda- 9
setting perspective
CHAPTER 3 Global Health and domestic policy - what motivated the 21
development of the German Global Health Strategy?
CHAPTER 4 Foreign policy and health - an explorative study of the inclusion 39
of health in the Strategic Partnerships between the
European Union and the BRICS countries
CHAPTER 5 Getting rid of the noise – a review of popular claims and concerns 63
in the debate on the health sector impacts of TTIP
CHAPTER 6 The workforce for health in a globalized context - global 81
shortages and international migration
CHAPTER 7 Improving the assessment and attribution of effects of 93
development assistance for health
CHAPTER 8 General discussion and conclusion 101
VALORIZATION ADDENDUM 111
REFERENCES 115
APPENDICES 127
SUMMARY / SAMENVATTING 137
ACKNOWLEDGEMENTS 145
CURRICULUM VITAE & LIST OF PUBLICATIONS 147
CHAPTER 1
General introduction and objective of
this dissertation
1
General Introduction and objectives of this dissertation
During the past decade ‘global health’ has become a buzzword in both policy and
practice, and an increasing number of European organizations and institutions are
scaling up their activities under the umbrella of a ‘global health’ terminology. Also
from an academic perspective, there has been a substantial increase in publications
that are making use of this term. Figure 1.1 shows that the incidence of new publi-
cations referring to ‘global health’ in the title has continuously risen during the past
years.
400
350
300
250
200
150
100
50
0
Figure 1.1: Number of new publications with ‘Global Health’ in title (in PubMed)
The emergence of a ‘global health’ terminology is accompanied by a discourse
about its concrete meaning, its scope, the health issues covered by it and its added
value compared to established research areas such as ‘public health’ or ‘interna-
tional health’. The debate is further mirrored by a plethora of definitions for global
health, which have been appraised, discussed and compared extensively (for com-
parative reviews of definitions, see Beaglehole et al. (2010) and Campbell, Pleic and
Connolly (2012)).
What is global health?
The discourse on the conceptualization, scope and goals of ‘global health’ is far from
heaving reached consensus. Particularly in Europe, a clear vision for global health
has been strikingly absent (The Lancet, 2012). This unclarity among European actors
2
has often been attributed to the inherently multidimensional nature of global
health, the perspectives of those framing the concept and the contexts in which it is
applied (Haines, Flahault & Horten, 2011).
In an attempt to distinguish global health from other fields of research, Koplan et al.
(2009) justify a co-existence of global health next to established areas such as ‘pub-
lic health’ or ‘international health’ by highlighting differences in geographical reach,
level of cooperation, target groups, access to health and differences in the included
disciplines. This argument however, has not been uncontested. Fried, Bentley et al.
(2010) argue that ‘global health is public health’, only with an international dimen-
sion to it. Adding to this debate, Bozorgmehr (2010) claims that global health issues
do not only refer to the worldwide- or transnational characteristics of health deter-
minants, but more explicitly to a supraterritorial perspective on health. According to
the author, international health and public health should focus on transnational
health issues, whereas a ‘global health’ focus should target the global social space in
which health related decisions are taken - and less on the collection and interaction
of smaller geographical units (Bozorgmehr, 2010). While each of these perspectives
accentuates different characteristics of global health, they commonly share a
recognition that in today’s world, the health of populations is impacted by trans-
cending national boundaries, the influence of globally emerging forces, and a sense
of globally shared responsibilities in solving these issues.
The global health understanding of this dissertation
In order to clarify the global health understanding of this dissertation a working
definition for ‘global health’ is essential. In this regard, this dissertation will build on
a framework developed by Frenk, Gómez-Dantés & Moon (2014) who identify three
‘strands of action’ that are currently performed under a ‘global health’ terminology.
Accordingly, global health should be concerned with:
1. Activities within the health sectors, including global disease outbreaks and
pandemics as well as international agreements and cooperation in health;
2. Health in the context of development and poverty reduction;
3. Policy initiatives in other sectors with cross border implications that are of
high relevance to health (Frenk, Gómez-Dantés & Moon, 2014).
The first area of global health assumes that contemporary public health action has
to incorporate a global perspective in order to protect and improve population
health. The most prevalent example here is the control of disease outbreaks across
borders. Outbreaks such as HIV/AIDS, SARS, or the 2014 Ebola outbreak in West
Africa are typical examples that illustrate the need for a new approach to public
health that incorporates a global view and global solutions. Additionally, newly
emerging health challenges such as Antimicrobial Resistance (AMR) or the ongoing
3
Description:discussing and developing national policy frameworks to tackle health issues of global concern This review attempts to analyse the global health agenda-setting process in the. European Union (EU) the need to increase the EU's influence and visibility on health matters to 'match its economic and
