Minds without borders: integrating social psychology into global health diplomacy

In addressing the escala/ng challenges of global health crises, we propose a conceptual model integra/ng key insights from social psychology into the prac/ce of health diplomacy. This lens allows to understand and navigate the human dimensions of global health efforts, emphasizing the importance of integra/ng social-psychological knowledge into global health efforts. By focusing on contact, iden/ty, and norms, it allows examina/on how these elements influence behaviors and partnerships in global health. Global mental health is increasingly recognized as a cri/cal component of public health, influencing not only individual well-being but also societal stability and interna/onal rela/ons (PaFerson et al., 2020; WHO Global Health and Peace Ini3a3ve (GHPI), n.d.). Mental health challenges – exacerbated by conflicts, displacement, climate change, and global health crises – transcend na/onal borders that require coordinated efforts across countries. In addi/on, mental health can pose a serious pre-condi/on for transgenera/onal violence. Augsburger and Jacob (2021) discuss how trauma, par/cularly post-trauma/c stress disorder (PTSD), contributes to cycles of violence, especially in conflict and crisis regions. PTSD can perpetuate aggression, which complicates reconcilia/on processes, as former vic/ms oSen become perpetrators. Effec/ve reconcilia/on and stabiliza/on must include mental health recovery programs to break violence cycles, reduce s/gma/za/on, and facilitate reintegra/on and reconcilia/on, emphasizing the need for community-based mental health structures. This urgency places mental health at the forefront of health diplomacy – that is, the interna/onal and cross-sector collabora/on between governments, organiza/ons and communi/es aimed at jointly addressing global health challenges. Health diplomacy holds par/cular significance in track 2 and track 3 diplomacy – terms commonly used to describe informal channels of interna/onal engagement that complement official state-led nego/a/ons (track 1 diplomacy). Whereas track 1 diplomacy involves formal interac/ons between government representa/ves, track 2 diplomacy refers to semi-official dialogues and collabora/ve efforts among non-state but influen/al actors, such as academics, policy experts, former officials and thought leaders. These actors engage in dialogue processes aimed at reducing tensions and shaping policy op/ons outside the constraints of official poli/cal posi/ons. Track 3 diplomacy, in contrast, focuses on even more grassroots-level efforts. It involves the engagement of civil society actors, including non-governmental organiza/ons (NGOs), faith-based groups, community leaders, and ac/vists. These ini/a/ves seek to build trust, promote intercultural understanding and foster peace through community-driven approaches. In the context of global health, track 2 and 3 diplomacy play essen/al roles by enabling coopera/on on shared health challenges, especially in poli/cally sensi/ve contexts where official diploma/c rela/ons may be strained or absent. Unlike tradi/onal diploma/c efforts that oSen focus directly on resolving poli/cal or economic dispari/es between groups, health diplomacy operates as an indirect interven/on. It does not directly address group dispari/es but can s/ll exert considerable influence by leveraging the interconnected nature of global health challenges. At its core, social psychology is the study of how individuals' thoughts, feelings, and behaviors are influenced by their social environments (Morawski & Bayer, 2013). It explores phenomena such as group dynamics, prejudice, iden/ty forma/on and social norms, all of which are relevant to global mental health and health diplomacy efforts. Social psychology offers tools to understand how s/gma is perpetuated, how intergroup conflicts arise, and how collec/ve ac/ons are mobilized. These insights are cri/cal for health diplomacy, where success oSen depends on naviga/ng complex interpersonal and intergroup dynamics. By integra/ng socio-psychological principles, health diplomacy can move beyond top-down solu/ons that usually directly address conflict by leveraging on important socio-psychological principles. We will now expand on a selec/on of these principles below. Social Iden3ty: Channelling Group Dynamics for Global Health Social iden/ty theory (Tajfel, 1982) offers valuable insights into how group membership shapes behavior, abtudes and percep/ons. Individuals derive a sense of self from their group iden//es, which can either foster inclusion and solidarity or exacerbate divisions (Fes/nger, 1954). This dynamic is especially relevant in the context of global health, where s/gma, exclusion and inequality oSen undermine access to care (Henking et al., 2023). Recognizing and affirming cultural and social iden//es can foster trust and engagement, while promo/ng shared iden//es – such as a global health iden/ty – can unite disparate groups under a common purpose (Gaertner et al., 1993; Stone & Crisp, 2007). For example, framing climate change's health impacts as a collec/ve challenge could inspire cross-border solidarity and coopera/ve ac/on (Batalha & Reynolds, 2012; Knab & Steffens, 2018). Promo/ng a shared iden/ty could also help reduce s/gma around mental health by encouraging the recogni/on of psychological wellbeing as a universal concern rather than an individual weakness or taboo. Selec/ng a shared iden/ty frame is especially difficult in intractable conflicts marked by collec/ve – rather than merely individual – trauma which impacts capaci/es for peace processes (Koh, 2021). Compe//ve vic/mhood – an intergroup dynamic in which each side seeks recogni/on as the "true" or greater vic/m to gain moral standing and jus/fica/on – hardens group boundaries and undermines superordinate iden/ty-building based on social groups (Noor et al., 2012); by contrast, health-anchored iden//es are oSen less poli/cized and could offer a more unifying basis for coopera/on. The Contact Hypothesis: Building Trust Through Interac3on The contact hypothesis (Brown & Hewstone, 2005) emphasizes the poten/al of intergroup contact to reduce prejudice and foster trust. When individuals from different groups interact under condi/ons of equality, shared goals, coopera/on and ins/tu/onal support, they are more likely to overcome biases and build mutual understanding (the contact situa/on can s/ll have a posi/ve impact even if not all condi/ons are met see Pebgrew & Tropp, 2006). Within health diplomacy, this principle can guide ini/a/ves that bring together diverse stakeholders – na/ons, communi/es and organiza/ons – to collaborate on shared health challenges. For instance, during vaccine distribu/on campaigns, fostering contact between interna/onal health teams and local leaders has been shown to build trust, reduce resistance, and enhance the perceived legi/macy of interven/ons (WHO, 2017). Thus, a deliberate use of such contact opportuni/es could strengthen coopera/on in health efforts. Project Rozana – an interna/onal organiza/on connec/ng Israeli and Pales/nian health care professionals – shows how their programs built on contact advanced cross-border collabora/on (Bkeirat, 2025). Health diplomacy efforts can also func/on as an indirect contact interven/on by fostering extended contact between groups through collabora/ve health ini/a/ves (Cameron et al., 2011; Wright et al., 1997). Extended contact theory posits that observing posi/ve interac/ons between members of different groups – such as through partnerships in health programs – can reduce prejudice and promote intergroup understanding without direct personal interac/on. While extended contact tends to be less impacmul than direct interac/ons (Brown & Paterson, 2016), results from a meta-analysis suggest that it can produce small to medium posi/ve effects on intergroup abtudes (Zhou et al., 2019). Health diplomacy ini/a/ves that bring together representa/ves from diverse cultural, social, or poli/cal backgrounds to address shared health challenges can create opportuni/es for symbolic and vicarious contact. These efforts could promote narra/ves of coopera/on, mutual respect, and trust, which can shiS percep/ons, challenge stereotypes, and influence broader social norms. By strategically highligh/ng these success stories and amplifying their visibility, health diplomacy can create a ripple effect, encouraging further collabora/on and reducing tensions in other domains (Halperin et al., 2012). Leveraging this form of extended contact within global health efforts can enhance their impact by not only addressing health dispari/es but also fostering greater social cohesion and solidarity across divided groups. Contact interven/ons have also received cri/cism by poten/ally producing an 'irony of harmony', in which power asymmetries are perceived as less salient (Gilad et al., 2021; Saguy et al., 2009). Embedding structured perspec/ve-giving – especially priori/zing voice for disadvantaged groups – into health-diplomacy contact programs can correct status asymmetries, build felt respect and mutual trust, and translate into more durable coopera/on (Bruneau & Saxe, 2012; see also Rappaport, 1995). Thus, the methods and tools need to be embedded in the broader socio-psychological context, in which for example norms play an important role. Emphasizing Equal Partnerships and Coopera3on or Maintaining Inequali3es? Research in social psychology highlights that helping behaviors are oSen shaped by implicit norms about power and dependency (Nadler, 2002). Dependency-oriented helping refers to a form of assistance in which support is provided in a way that reinforces the recipient's reliance on the helper, limi/ng opportuni/es for autonomy and capacity-building. In the context of global mental health, this can occur when interven/ons are designed and delivered by external actors without engaging local communi/es, professionals, or cultural knowledge systems. For example, when interna/onal organiza/ons implement mental health programs in low-and middle-income countries using imported models and foreign personnel – without training local providers or adap/ng to local contexts – communi/es may remain dependent on external aid. While such efforts may offer short-term relief, they risk undermining local ownership, sustainability and trust and may ul/mately reinforce systemic inequali/es in global health governance. Thus, dependency-oriented helping, where the helper maintains control and limits the recipient's autonomy, could perpetuate inequali/es and undermine trust. For example, a real-world case study of health organiza/ons in Malawi showed how limited discre/on over aid and donor-driven control created a cycle of mistrust and diminished local capacity, undermining coopera/on and health outcomes (but see bidirec/onal impact of trust on power outline in Anderson et al., 2021). In global health contexts, such as delivering aid to marginalized communi/es, this type of helping can reinforce s/gma and disempower the very groups it aims to support (Alvarez et al., 2018; Nadler & Chernyak-Hai, 2014). To exemplify, during the COVID-19 pandemic, high-income countries were inves/ng in securing high amounts of the vaccines and later shared them for reasons of solidarity, but it could be seen as means to assert a geo-poli/cal advantage (Kickbusch & Liu, 2022). In addi/on, people receiving dependency-oriented help infer status maintaining mo/va/ons from the help provider – which could then further stain coopera/ve rela/ons as the help recipients tend to show lower levels of coopera/on inten/on in return (Shi et al., 2024). Especially in conflict-torn contexts or contexts with a long history of intergroup conflicts, there might be a high level of threat percep/on. When dominant groups perceive others as threats – whether due to cultural differences, resource compe//on, or poli/cal instability – these percep/ons can manifest in paternalis/c helping behaviors (Celikkol et al., 2021; Halabi et al., 2008). For example, aid programs may focus on allevia/ng immediate symptoms without addressing systemic inequi/es, reinforcing a sense of dependency. Social norms play a crucial role in shaping how such programs operate and influence behavior, making them highly relevant for promo/ng social change (González, 2024; Tankard & Paluck, 2016). But recent research indicates an interplay between subjec/ve social norms and threat percep/ons: when threat percep/ons are coupled with strong perceived social norms to help (for example by global health ini/a/ves with ins/tu/onal support), this could lead to an especially high level of dependency-oriented helping (Knab et al., 2025). This dynamic is par/cularly complex in the global health context, where norms embedded in health interven/ons oSen reflect Western values and assump/ons. The export of these norms can uninten/onally undermine local knowledge systems and community autonomy. This is especially evident in the realm of mental health, where Western norms tend to emphasize individual pathology, clinical diagnoses and formal treatment, while in many other cultural contexts, mental distress may be interpreted through social, spiritual, or communal lenses. Imposing Western conceptualiza/ons of mental illness may not only lead to culturally incongruent interven/ons but also risk s/gma/zing local coping strategies and support systems. As a result, well-inten/oned efforts to promote health and wellbeing may contribute to disempowerment, reinforce unequal power dynamics and inhibit sustainable, locally driven solu/ons. A cri/cal reflec/on on which norms are being promoted and whose voices are shaping them, is thus essen/al to ensure that global health efforts support rather than compromise empowerment and equity. Past research has also shown that reconcilia/on is enhanced when interven/ons 'speak' to peoples' specific needs. In detail, perpetrators and vic/ms have different underlying needs and acknowledging them before bringing the past adversary groups together could have a beneficial impact (Shnabel et al., 2009). In summary, the concrete way of interac/ng and coopera/on needs to be reflected upon, so that ini/a/ves can lead to the empowerment of communi/es and thus strengthen the trust between the involved par/es. For instance, research indicates that asking recipients how they would like to be helped reduces the likelihood of offering dependency-oriented assistance. These findings highlights the importance of involving both help providers and recipients equally in the process (Nadler et al., 2009). Integra3ng Contact and Iden3ty for Health Diplomacy By integra/ng the contact hypothesis and social iden/ty theory, this approach addresses both interpersonal and group-level dynamics. Key applica/ons include: 1. Promo3ng Shared Goals: Diploma/c ini/a/ves can frame global health challenges as shared threats, fostering a collec/ve "global health" iden/ty – but employ culturally sensi/ve communica/on that respects exis/ng iden//es while highligh/ng collec/ve goals to bridge divides. 2. Facilitate contact: Structured opportuni/es for intergroup contact – such as cross-border health collabora/ons – can reduce biases and perceived status differences, par/cularly when all par/es are seen as equal contributors. 3. Redefining Norms: Before ini/a/ng interven/ons, conduct detailed assessments of local norms around mental health, wellbeing, and social support prac/ces. 4. Establish inclusive Partnerships: Equal partnerships help establish new norms of coopera/on and reciprocity, moving away from the implicit hierarchies that oSen characterize global health efforts. This could be by dedica/ng a por/on of project budgets specifically to training healthcare workers in mental health care, conflict resolu/on, and culturally adapted treatment prac/ces – designed as a bilateral exchange in which both partners share and develop skills and competencies. Conclusion We propose that a socio-psychological lens is beneficial for health diplomacy efforts and can address both the technical and social dimensions of global health challenges to contribute to transcending divisions and promote trust and coopera/on.