Public health diplomacy in Central Asia: a scoping review.

BACKGROUND

Central Asia comprising Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan, confronts a complex array of health challenges shaped by the post-Soviet transition, including fragmented health systems, a dual burden of communicable and non-communicable diseases, environmental degradation, healthcare inequality, and competing geopolitical influences. Public health diplomacy has emerged as a critical instrument for addressing these transnational challenges.

OBJECTIVES

This scoping review aimed to map and synthesize the existing evidence to examine the role of public health diplomacy in strengthening health governance and regional and international health cooperation.

METHODS

Following the Arksey and O'Malley scoping review framework, this paper used a systematic search of PubMed, and Google Scholar. Studies published between 2000 and 2025 addressing health diplomacy, health governance, cross-border cooperation, or health system reform in Central Asia were included. Data was extracted using a standardized charting form and synthesized through descriptive and narrative thematic analysis.

RESULTS

Seventeen studies met the inclusion criteria. Kazakhstan was the most extensively studied country (n = 4), followed by Uzbekistan (n = 2), Kyrgyzstan (n = 1), and Tajikistan (n = 1). No country-specific study addressed Turkmenistan. Key findings revealed: (i) all five countries continue to navigate the post-Soviet health transition with uneven progress toward UHC; (ii) significant intra-national healthcare inequalities persist, particularly in Kazakhstan's rural areas; (iii) environmental health threats including transboundary water pollution, industrial contamination, and household air pollution, demand coordinated diplomatic responses; (iv) the European Union uses health as a soft-power instrument, while China's Belt and Road Initiative and the SCO represent expanding but under-evaluated platforms for health cooperation; (v) Russia's influence persists through institutional legacies and migrant health governance; (vi) centralized, top-down health communication hinders public trust across the region; and (vii) no health diplomacy training program exists for Central Asia. The strongest SDG 3 alignment was with target 3.8 UHC, while maternal mortality, child health, and substance abuse targets remained unexamined through a PHD lens.

CONCLUSION

Public health diplomacy has significant potential to strengthen health governance and regional cooperation in Central Asia. Advancing this agenda requires stronger regional collaboration, context-specific capacity building, greater evidence generation, and systematic evaluation.