Dr Richard Horton (Editor-in-Chief, The Lancet, and Senior Vice President, The Lancet Group), in his recent essay Health: The Forgotten Foreign Policy Goal (The Lancet, 2026), argues that contemporary debates on soft power misjudge the sources of international influence by excluding health from the concept altogether.
Standard indices measure attraction through culture, governance, diplomacy, and economic capacity, yet omit the ability of states to protect life and wellbeing. Horton contends that this omission produces a distorted hierarchy of power because public health performance often generates legitimacy and persuasion more reliably than material strength.
The article surveys cases frequently overlooked in discussions of global influence. Countries with limited military or economic weight have nonetheless accumulated standing through sustained health achievements. The Gambia gained scientific credibility through long-term infectious disease research partnerships; Bangladesh improved social indicators through community health interventions; Tanzania shaped development agendas through maternal and child health initiatives; Cuba translated preventive medicine into diplomatic capital; Thailand’s universal coverage elevated its international reputation; and India’s large-scale community health worker programme became a global reference point. In each case, external recognition followed demonstrated capacity to deliver welfare rather than coercion or wealth.
Horton summarises the implication directly: influence flows from trust in a state’s social competence. When populations across borders depend on its expertise, training, pharmaceuticals, or models of care, authority emerges without formal alliance or ideological alignment. Health cooperation thus operates as a durable form of persuasion because it is grounded in everyday survival rather than abstract values.
From this analysis Horton advances three claims. First, prevailing soft power frameworks confuse visibility with legitimacy by prioritising narrative appeal over welfare capability. Second, international authority grows from practical cooperation in research, treatment, and prevention, which forges deeper ties than diplomatic messaging. Third, governments that treat health as domestic policy alone underestimate its role in shaping status and partnership networks.
The article concludes that global influence rests partly on the capacity to safeguard human life. Foreign policy strategies that neglect health investment misunderstand the sources of authority, since credibility abroad depends as much on care delivered as on power projected.