Abstract

The Forum for Economic and Trade Cooperation between China and Portuguese-speaking Countries, better known as Forum Macao, founded in 2003, has been acting as a link between China and Portuguese-speaking countries for 20 years. Since 2016, the Permanent Secretariat of Forum Macao has published a yearbook highlighting the main activities it carried out in the previous year. This article focuses on analyzing Forum Macao's role as an organizer and mediator of Global Health initiatives by analyzing all the articles published in its yearbooks between 2016 and 2023. We found 34 articles dealing with a health-related topic, with almost two thirds related to traditional Chinese medicine, reports of frequent organization of activities that foster international cooperation in health, as well as active participation during the first year of the Covid-19 pandemic. Forum Macao is a multilateral platform for dialogue between China, Macao and the Portuguese-speaking world, with the health agenda and the dissemination of traditional Chinese medicine occupying a prominent place in its yearbook.

Keywords:
International Cooperation in Health; Health Diplomacy; Global Health; Portuguese-Speaking Countries; Traditional Chinese Medicine

Introduction

The Forum for Economic and Trade Cooperation between China and Portuguese-speaking Countries (Forum Macau), 中国-葡语国家经贸合作论坛 in Chinese, is a multilateral economic and trade cooperation mechanism set up by the Chinese government in October 2003, just four years after the region's sovereignty was transferred from Portugal to the People's Republic of China (PRC). Its aim is to use the Macau Special Administrative Region (MSAR) - a Chinese territory with Portuguese as one of its official languages - as a platform for connecting and promoting the development of economic, commercial and cultural relations between the PRC, the Macau SAR and Portuguese-speaking countries (PSC).

The Republic of Angola, the Federative Republic of Brazil, the Republic of Cape Verde, the Republic of Guinea-Bissau, the Republic of Mozambique, the Portuguese Republic and the Democratic Republic of East Timor, as well as the PRC itself (represented by the MSAR), have participated in Forum Macau since its foundation. The Democratic Republic of São Tomé and Príncipe joined the organization in 2017/03, after breaking diplomatic relations with the Republic of China (Taiwan) in favour of the PRC, while the Republic of Equatorial Guinea joined in 2022/04, thus obtaining the participation of all PSCs (Macau, 2018, 2023).

The benefits of the existence of Forum Macau for the Chinese government can be understood as political, diplomatic and economic. According to Peng (2006PENG, I. K. Uma análise política e económica sobre a "Plataforma de apoio à cooperação económica e comercial entre a China e a Lusofonia". Revista Administração, p. 707-724, 2006.), the display to the world of a rich and stable Macau serves to demonstrate that the policy of "One country, two systems" (一国两制) is effective and has the potential to generate great common prosperity. In the diplomatic field, the use of the MSAR as a platform for promoting PRC-PSC relations is in line with the PRC's desired prominence in the field of South-South relations. As for the economic aspects, the existence of Forum Macau increases the prospect of doing business between Chinese entities and those belonging to the PLP, facilitating the entry of Chinese products and services to a market of approximately 287 million people, as can be seen extensively in the economic exchange sessions present in the annual reports issued by the Permanent Secretariat of Forum Macau (Macau, 2016; 2017; 2018; 2019; 2020; 2021; 2022; 2023). In addition, the MSAR itself gains several economic benefits because, elevated to the status of a symbol of the union between the PRC and the PSC, and between the PSC themselves, the region can diversify its international role, ceasing to be known only as the land of casinos and the "Las Vegas of the Orient" to serve as a hub for education and services linked to Lusophone culture (Mendes, 2013MENDES, C. A relevância do Fórum Macau: o Fórum para a Cooperação Econômica e Comercial entre a China e os Países de Língua Portuguesa. Nação e Defesa, 2013.).

In recent decades, Traditional Chinese Medicine (TCM) has gained increasing popularity among the PSC. In 2014, Portugal was the first European country to regulate the professions of TCM specialist and acupuncturist (Portugal, 2014a; 2014b). Also in 2014, Brazil regulated the trade and production of TCM products, deeming as a health infraction the sale of TCM products with a composition different from that described in the official Chinese Pharmacopoeia (ANVISA, 2014).

Taking advantage of this increase in popularity, the promotion of TCM practices and products in the PLP has become one of Forum Macao's priorities, also boosted by its geographical proximity to the Traditional Chinese Medicine Scientific and Industrial Park for Guangdong-Macao Cooperation (hereinafter referred to as "Park"), 粤澳合作中医药科技产业园 in Chinese. Based on the island of Hengqin, a district of the city of Zhuhai that immediately borders the MSAR, the Park was established in 2011/04 through the Guangdong-Macao Cooperation Framework Agreement and is publicly managed (MSAR, 2011). The Park has strategic cooperation agreements with all Forum Macao members in the areas of hospital supplies, pharmaceuticals, food safety and TCM education and training (Song ., 2021SONG, H.; GAO, J.; JIA, H. Usage and promotion on Chinese medicine in Portuguese-speaking countries. Pharmacological Research, v. 168, p. 105591, 2021.). Macau is also home to the State Reference Laboratory for Quality Research in Chinese Medicine, 中药质量研究国家重点实验室 in Chinese, belonging to the Institute of Chinese Medical Sciences of the University of Macau, the first reference laboratory in TCM at the national level (Song et al., 2021).

The participation of Forum Macao as a player in the field of Global Health is due not only to its geographical proximity to the Park, but also to the organization and holding of high-level events and visits aimed at disseminating and training TCM professionals. In particular, the Colloquium on Cooperation in Traditional Medicine between China and Portuguese-speaking Countries has been held in partnership with the Park every year since 2016.

Forum Macao has also taken an active part in combating and preventing the Covid-19 pandemic by organizing donations of medical supplies and webinars on international cooperation on Covid-19 (Macao, 2021). Thus, the aim of this study is to analyze the work of the General Secretariat of Forum Macao in activities related to the field of health, with a special focus on the field of Global Health, through the articles found in its yearbooks published between 2016 and 2023.

Methodology

Since 2016, the Permanent Secretariat of Forum Macao has published the "Yearbook of the Permanent Secretariat of the Forum for Economic and Trade Cooperation between China and Portuguese-speaking Countries (Macao)" on its website. With eight editions as of the date of writing this article (Macau, 2016; 2017; 2018; 2019; 2020; 2021; 2022; 2023), the yearbook "aims to systematically record the important activities and main work carried out throughout the year by the Secretariat" (Macau, 2013).

Having obtained digital copies of each of the yearbooks through the Forum Macau website (https://www.forumchinaplp.org.mo/pt/publications-data-4/annual-reports/), a search was carried out for specific keywords selected for their relation to the health area, by individually reading each of the titles of the articles that make up the yearbooks, which were: "health/healthy", "medicine/medical", "hospital", "pharmaceutical", "food", "biotechnology" and "Covid-19".

After locating at least one of the keywords described above in the title of the article, the article was read in full to confirm its relation to the health area and, if so, the parties involved, the year of execution, and the specific health area addressed by the article were listed. The specific health areas identified in the Permanent Secretariat's negotiations were "food safety", "traditional medicine", "traditional medicine industry", "international cooperation in health", "Covid-19", "financial cooperation in Covid-19" and "donation of P.P.E.s for Covid-19".

Articles that dealt specifically with food safety between countries, food management by non-commercial entities, and dialog between government agencies directly related to food safety were defined as belonging to the "Food Safety" area. "Traditional Medicine" defines articles that deal with the dissemination and training of TCM professionals, "Traditional Medicine Industry" covers articles that focus on the industrial development and trade of TCM supplies. The "International Health Cooperation" area deals with articles on health cooperation agreements and large-scale health conferences. Articles with the theme "Covid-19" appear from the 2020 edition onwards, after the start of the Covid-19 pandemic, and will be discussed in more detail in the results and discussion section.

Articles dealing with visits by foreign delegations to the PRC or the MSAR were excluded from the research, as were visits by the Permanent Secretariat to the PSC when the main subject of the visit was not focused on the health agenda. Also excluded were articles that contained the terms "food" but did not focus on food security or humanitarian aid (e.g. negotiations on trade in food items). Likewise, mentions of Covid-19 were only kept when related to fighting the pandemic, supplies of medical supplies and related areas, and those dealing with economic, commercial and other non-health issues were excluded.

Results

The results of the survey are listed in Tables 1 and 2 below.

In the yearbooks published in the period 2015-2022, 34 articles were identified that corresponded to the health area, equivalent to 7.87% of the 432 articles published. The year with the highest prevalence of this type of topic was 2020, the first year of the Covid-19 pandemic, with 17.14% of the yearbook dedicated exclusively to the health area, followed by 2016, the year of the 5th Ministerial Conference of Forum Macao, with 13.35%. On average, each yearbook was published with a total of 54 articles, 4.24 (7.87%) of which were related to the health area (Table 1).

Table 2 shows that the most prevalent health topics in the period 2015-2022 were, in descending order: Traditional Chinese Medicine (12 occurrences), Traditional Medicine Industry (10 occurrences), International Cooperation in Health (8 occurrences), and Food Security (4 occurrences). Additionally, after the start of the COVID-19 pandemic in 2020, seven occurrences of articles were identified that included this theme, including one occurrence of Donation of PPE for COVID-19, categorized as part of the International Health Cooperation theme.

As for the Forum Macao member countries most involved in health negotiations initiated or mediated by the organization, in descending order of occurrence, they were: MSAR (33 occurrences), PRC (31 occurrences), Cape Verde (14 occurrences), Angola (13 occurrences), Guinea-Bissau (12 occurrences), Mozambique (12 occurrences), Portugal (12 occurrences), Brazil (9 occurrences), São Tomé and Príncipe (9 occurrences), East Timor (7 occurrences) and Equatorial Guinea (1 occurrence).

In 2015, all health-related events took place between the Permanent Secretariat and PRC government entities. However, as of 2016, the year of Forum Macao's 5th Ministerial Conference, the records of health initiatives organized and/or mediated by the organization became more cosmopolitan, encompassing all members of the organization.

The Permanent Secretariat of Forum Macao was present as a participant and/or mediator in negotiations in 33 of the 34 health initiative events listed, in addition to one event where it acted as an observer in the signing of an agreement in the area of food inspection and safety between the PRC and Portugal. Thus, the Permanent Secretariat of Forum Macao participated, directly or indirectly, in all the events listed between 2015 and 2022. Articles that had representatives of the PRC together with the Permanent Secretariat of Forum Macao or the MSAR government as the only parties present appeared 13 times, or 38.23% of the total, and were more prevalent during the pre-pandemic period, with 12 occurrences until 2019 and only 1 from 2020 onwards.

Of the 31 instances of participation by representatives of the PRC, the Permanent Secretariat was present in 29 of them as a participant and/or mediator in negotiations and in one event where it acted as an observer in the signing of an agreement in the area of food inspection and safety between the PRC and Portugal. Equatorial Guinea's low participation can be explained by the fact that it only joined Forum Macau in 2022. Although São Tomé and Príncipe also joined late (in 2017), the country had more participations in health-related discussions than East Timor, with seven, and almost as many as Brazil, with nine.

The health topics most frequently covered during the negotiations described in the yearbooks were "Traditional Medicine Industry" and "Traditional Chinese Medicine". Together, their 22 occurrences correspond to 64.7% of all the topics covered in the period investigated. "International cooperation in health" appeared 23.5% of the time. These findings are not surprising, given the geographical proximity between Macau and the Park, which facilitates visits by official committees from the Secretariat to the Park, and participation by Park delegations in events organized by Forum Macau. It should be noted that the annual conferences on traditional medicine organized by Forum Macau are directly funded by the Park.

The theme of "International Cooperation in Health" appears in eight different articles, especially in the 2019-2020 yearbooks, in which seven articles were found. The remaining article is in the 2016 Yearbook, when the 5th Ministerial Conference of Forum Macao took place. Bearing in mind that the articles in the 2019 Yearbook deal with three separate visits by the Ministers of Health of Angola, Cape Verde and São Tomé and Príncipe to the Forum Macao headquarters, it is possible to state that, in the pre-pandemic period, all the occurrences of articles on "International Cooperation in Health" took place during face-to-face visits by Ministers of Health to Forum Macao and, in the post-pandemic period, they took place during the webinars organized by Forum Macao.

The 2020 Yearbook, marked by the beginning of the Covid-19 pandemic (PAHO, 2020), had all its health-related articles marked by the theme of fighting the disease. In total, the Covid-19 theme was part of 21.2% of all the articles found. And 2020 was also the year in which Brazil had its most active participation in the health talks organized by Forum Macao, with 50% of all occurrences mentioning the country taking place that year. The pandemic served as an opportunity for Forum Macao to use its status as a symbol of Portuguese-speaking integration, organize efforts to combat Covid-19 and exchange knowledge among its members, which was evidenced by the number of online courses and webinars it organized.

Discussion

This study showed that almost a tenth (7.87%) of the articles published by the Yearbook of the Permanent Secretariat of Forum Macao were health-related, with a strong focus on Traditional Chinese Medicine and the Traditional Medicine Industry (12 and 10 articles, respectively). More than a third of the health talks described in the articles had representatives of the People's Republic of China and the government of the Macau Special Administrative Region as the only participants (38.23%), a trend that has been decreasing in recent editions of the Yearbook in favour of more multilateral discussions.

Since the beginning of the 21st century, the creation of regional cooperation forums has been gradually building a "sinosphere", where different nations make up and integrate a network of institutions that complement each other and have China (or, in the case of Forum Macau, the MSAR) as an important or central part of their dealings (Costa, 2020COSTA, C. M. O discurso chinês para os países africanos de língua portuguesa: o papel do Fórum Macau. O discurso chinês para os países africanos de língua portuguesa: o papel do Fórum Macau, n. 65, p. 43-55, 2020.). These forums, such as the Forum on China-Africa Cooperation, the Macau Forum or even the BRICS summits "have allowed China to broaden its sphere of influence and attract more and more countries to its diplomatic fold" (Costa, 2020), expanding the areas where it can exert its influence without breaking the principle of multilateralism, increasing its number of trading partners, as well as popularizing the use of traditional Chinese medicine (Fróio, 2012FRÓIO, L. A expansão chinesa a partir da medicina tradicional. ComCiência, n. 137, p. 0-0, 2012.; Costa, 2020).

With the exception of Portugal and Macau itself, all the countries participating in Forum Macao are considered low or middle income according to the World Bank's classifications (2023). These countries generally have fragile, fragmented and/or underfunded health systems, and find it difficult to obtain technological resources and professional training to provide adequate health care (Buss, 2010BUSS, P. M.; FERREIRA, J. R. Ensaio crítico sobre a cooperação internacional em saúde. Revista Eletrônica de Comunicação, Informação & Inovação em Saúde, v. 4, n. 1, 2010.). Multilateral institutions such as Forum Macao, by actively promoting dialogue and cooperation in areas such as health, development and encouraging the adoption of integrative practices such as traditional Chinese medicine - recurring agendas at its ministerial conferences and in the work of the general secretariat, such as the organization of the Colloquia on Cooperation in the field of Traditional Medicine between China and Portuguese-speaking Countries - have the potential to act not only as a platform for rapprochement between the PSC and China, but also as an important player in the field of South-South health cooperation..

Portugal's presence at Forum Macau is of particular interest because, as Costa (2020COSTA, C. M. O discurso chinês para os países africanos de língua portuguesa: o papel do Fórum Macau. O discurso chinês para os países africanos de língua portuguesa: o papel do Fórum Macau, n. 65, p. 43-55, 2020.) points out:

We can see, then, that with its 20 years of existence, Forum Macau has shown itself to be a tool for uniting the PLP and proof that Macau has not yet lost its role as a harbour connecting China with the Portuguese-speaking world. The greatest potential of this article is to demonstrate, through documentary analysis, the capacity of Forum Macau and its Permanent Secretariat to be an active player in the field of global health among the PLP. The main limitation is that although Forum Macao was created in 2003, the first edition of the Yearbook was only published in 2015, restricting the scope of the analysis to a period of less than a decade.

Conclusion

Since its creation in 2003, Forum Macao has been an organisation that seeks to strengthen economic and cultural ties between the People's Republic of China, the Macao Special Administrative Region and all Portuguese-speaking countries. It has been seen in this article that Forum Macao is also active in the area of Global Health, especially with regard to Traditional Chinese Medicine and its industry, having consistently organised events and brokered agreements in this area. Forum Macau was also very active during the height of the Covid-19 pandemic, reinforcing its practical and symbolic role as a link between China and Portuguese-speaking countries.

Acknowledgements

The author would like to thank Professor Evandro Carvalho (ESD/UFF), for his encouragement and initial revision of the text and the team at the Support Office for the Permanent Secretariat of Forum Macau, for kindly sending me the complete edition of the 2015 Yearbook.

References

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