With its booming economy and surging population, Brazil is expected to emerge as one of the major global powerhouses of the 21st century. But the country's growing influence on the world stage is driven by more than just raw economic and demographic might. Brazil has been particularly adept among so-called BRIC (Brazil, Russia, India and China) nations at using a gently persuasive form of 'soft power' diplomacy—and the country is using public health issues in particular to leverage long-term economic and political gain.

Brazil's HIV/AIDS policy is probably the best example of what some experts have dubbed the country's 'health industrial complex'. In 1990, when more than 10,000 new AIDS cases were reported in the country, the World Bank famously predicted that Brazil would have 1.2 million infections by 2000. But thanks to universal provision of antiretroviral drugs, starting in 1996, and government social programs aimed at encouraging condom use and needle exchange, the number of people now living with HIV in Brazil sits at around 730,000, with a prevalence rate on par with that of the US.

Buoyed by its successful track record, Brazil has used its international reputation and expertise to help several sub-Saharan African countries confront their ongoing HIV epidemics. Over the past decade, for example, Brazil has sent delegates to Mozambique, Nigeria and Angola to build up pharmaceutical plants and then hosted workshops back in the capital city, Brasilia, for African health officials to gain technical training for analytical techniques and strategies for drug production.

“The ministry of foreign affairs has always wanted to market Brazil's success with AIDS,” says Eduardo Gómez, a political scientist at Rutgers University in Camden, New Jersey who has studied the geopolitical incentives that led Brazilian officials to help Africa combat the disease (Geo. Public Poly. Rev. 37, 15, 2009). “Brazil's not so focused on money, like the US, but on knowledge about how to build sustainable pharmaceutical companies, for example. Equally, it doesn't ask for access to oil [in return], like China, or try to redeem itself in some way like the US. It is trying to increase its standing.”

Brazil has similarly demonstrated global leadership when it comes to tobacco control, notes Kelley Lee, a health policy researcher at the London School of Hygiene and Tropical Medicine. Although the country is one of the biggest producers and exporters of tobacco in the world, Brazil established a strict national tobacco control program that led to a 35% drop in the adult smoking rate between the start of the effort in 1989 and 2003. As chronicled by Lee and her colleagues, Brazilian officials then promoted these advances and used their diplomatic channels to help build international consensus for the World Health Organization's Framework Convention of Tobacco Control, signed in 2003 (PLoS Med. 7, e1000232, 2010).

As a result, Brazilian diplomats have been appointed to a number of key positions within the World Health Organization (WHO) and the UN. Most recently, the country was also chosen to host the new South American Institute of Government in Health (ISAGS), which opened its doors in July in Rio de Janeiro as a place to facilitate the sharing of skills and ideas on public health between Latin American countries.

But tobacco control and HIV are not the only arenas for Brazil's soft but powerful diplomatic approach. “Whenever there are formal negotiations on global health issues”—for example, the WHO's April 2011 agreement on sharing influenza-virus samples or last month's UN High-Level Meeting on Non-Communicable Diseases—“Brazil is an active participant,” says Lee. “The country is certainly not a two-trick pony.”

In unpublished work, Gómez has examined how Brazilian diplomats are capitalizing on the country's policies toward tuberculosis and obesity. And João Augusto de Castro Neves, a political consultant based in Washington, DC, points to Brazil's leadership of the UN peacekeeping mission in Haiti as a demonstration to larger powers that it can handle affairs in its neighborhood of Latin America.

“That will give it better credentials to become a permanent member of the UN Security Council,” Castro Neves says. “Health is an area Brazil has a comparative advantage. It has a problem with military resources, some fiscal problems. But for the past 20 years Brazil has developed a lot of expertise in health.” By lending others a hand, it seems, health diplomacy is slowly helping Brazil to help itself.