Medicine's crucial concern with health is perennial, but its reflection, concepts, means change with the advance of science and social life. We present here a fascinating panorama of current medical discussions with their philosophical underpinnings, and queries as they have evolved from the past. The role of Tymieniecka's phenomenology of life is brought forth as the system of philosophical reference.

It was October 2014, and Ebola was raging out of control in Guinea, Liberia, and Sierra Leone. Margaret Chan, the World Health Organization's director‐general, defended the organization against charges that its response was late and ineffective: “We are a technical agency, with governments having first priority to take care of their people.” In January 2015, the WHO executive board undertook a systematic reform of the agency's performance, and Chan again offered a defense: I followed protocol, leaving it to (...) the Africa office (AFRO) to respond. Yet the three nations could not possibly have stemmed the outbreak alone, and AFRO was known to be dysfunctional.Ebola represents an inflection point requiring fundamental reform for the WHO. A failure of leadership will impact its status and legitimacy for a generation. Here, I offer five reforms that would transform it and ensure that it fulfills its constitutional mission as “the directing and coordinating authority on international health work.”. (shrink)

ArgumentScientific uncertainty is fundamental to the management of contemporary global risks. In 2009, the World Health Organization declared the start of the H1N1 Influenza Pandemic. This declaration signified the risk posed by the spread of the H1N1 virus, and in turn precipitated a range of actions by global public health actors. This article analyzes the WHO's public representation of risk and examines the centrality of scientific uncertainty in the case of H1N1. It argues that the WHO's risk (...) narrative reflected the context of scientific uncertainty in which it was working. The WHO argued that it was attempting to remain faithful to the scientific evidence, and the uncertain nature of the threat. However, as a result, the WHO's public risk narrative was neither consistent nor socially robust, leading to the eventual contestation of the WHO's position by other global public health actors, most notably the Council of Europe. This illustrates both the significance of scientific uncertainty in the investigation of risk, and the difficulty for risk managing institutions in effectively acting in the face of this uncertainty. (shrink)

Everyone knows that British doctors are emigrating and that other doctors, mostly from the third world, are immigrating to Britain. Also everyone thinks that he knows the reasons why. However, the Edinburgh Medical Group thought the various reasons for this medical migration should be examined more closely, and held a symposium (Chairman, Professor A S Duncan, Professor Emeritus of Medical Education in the University of Edinburgh) to examine the causes for medical migration at the present time. Medical teaching and (...) practice is still basically as it has been developed in the West and so overseas doctors trained in Britain take with them not only the medical knowledge and skills but also the attitudes of the West when they return to their own countries. Consequently they wish to settle in the towns and practise as consultants when the real medical problems in many of the developing countries are those of a rural population needing health care rather than treatment in what have been called `disease palaces'. As speakers made clear, a new responsibility must fall on those training doctors from overseas in the British medical schools to fit them not for the dream world of the sophisticated medical scene but for the realities of working in often badly equipped clinics and dealing with common conditions such as malnutrition and other problems of maternity and child health. The symposium also included discussions as to why British doctors wished to emigrate. Money seemed to be the most compelling motive, but opportunities were being limited for their migration for economic and political reasons. Finally, a look at the whole of the medical scene in Britain: perhaps the standard sought in Britain both by the doctor and the patient is too high and too individualistic. Events will show if this be true. (shrink)

Many scholars have historicized biopolitics with reference to the emergence of sovereign nations and their colonial extensions over the 18th, 19th and 20th centuries. This article begins to conceptualize and trace the history of biopolitics beyond the nation, arguing that the history of world health - the great 20th-century reach of 19th-century health and hygiene - should be understood as a vital politics of population on a newly large field of play. This substantive history of world (...) health and world population is analysed as sites for thinking about global bio-politics; and the article looks seriously at the interwar period as a point at which ‘the world’ (or Hardt and Negri’s ‘Empire’) was already challenging the idea of ‘inter/national’. (shrink)

HALLETT C and WAGNER L. Nursing Inquiry 2011; 18: 359–368 Promoting the health of Europeans in a rapidly changing world: a historical study of the implementation of World Health Organisation policies by the Nursing and Midwifery Unit, European Regional Office, 1970–2003The World Health Organisation (WHO) was inaugurated in 1948. Formed in a period of post‐war devastation, WHO aimed to develop and meet goals that would rebuild the health of shattered populations. The historical study (...) reported here examined the work of the Nursing and Midwifery Unit (NMU) of WHO’s European Regional Office during the later part of the twentieth century. The study examined archive sources lodged at the NMU archive. The sources included manuscripts relating to important NMU initiatives, reports and papers published by WHO, and a range of secondary sources. The study identified three main driving forces in the work of the NMU of the European Regional Office of WHO. One of the strongest of these was a drive to develop and promote the nursing profession within the countries of the European Region. The second was the promulgation and implementation of the positive public health strategies of WHO, particularly its ‘38 Targets for Health for All by the Year 2000’. The third focussed on securing equity across the European continent and on promoting the development of the nursing professions in poorer and less‐developed countries. The study concludes that the nursing professions in European states grew in strength and influence, and that the health of populations improved throughout the continent between 1970 and 2003. It discusses the extent to which the role of the NMU in these advances may have been significant. (shrink)

The field of global health has reached a critical juncture, where both its visibility and the complexity of its challenges are unprecedented. The World Health Organization, as the only global health actor possessing both democratic and formal legal legitimacy, is best positioned to capitalize on this new, precarious situation in public health and respond with the governance innovation that is needed to bring the increasingly chaotic network of activities and entities affecting health outcomes under (...) the fold of a centralized, standard-setting agency. One such proposed innovation to guide normative and strategic coordination in global health is the creation of a Committee C of the World Health Assembly that would promote consensus building and multi-stakeholder decision-making within the unique convening power of the World Health Organization. (shrink)

In January 2010 the Director General of the World Health Organization called for an “informal consultation on the future of financing for WHO” and in her opening remarks expressed the need to make the WHO fit for purpose given the unique health challenges of the 21st century.Margaret Chan referred to the constitutional role that WHO has to “act as the directing and co-ordinating authority on international health work” and stated clearly that global health leadership today (...) and for the future must be earned through strategic and selective engagement. She said, “WHO can no longer aim to direct and coordinate all of the activities and policies in multiple sectors that influence public health today.” This is a clear challenge that she has put to the global health community in recognition that WHO’s role must be clarified in the face of major change. (shrink)

“I want my leadership to be judged by the impact of our work on the health of two populations: women and the people of Africa.” This is how Dr. Margaret Chan, the current Director-General of the World Health Organization , described her leadership mission. The reason behind this mission is evident. Women and girls constitute 70% of the world’s poor and 80% of the world’s refugees. Gender violence against women aged 15–44 is responsible for more (...) deaths and disability than cancer, malaria, traffic accidents, and war. An estimated 350,000 to 500,000 women still die in childbirth every year. The negative health implications of absolute poverty are worst in Sub-Saharan Africa and South Asia. Hence, Chan aims to have the biggest impact on the world’s poorest people. (shrink)

In 2009, health authorities from Taiwan formally attended the 62nd World Health Assembly of the World Health Organization as observers, marking the country’s participation for the first time since 1972. The long process of negotiating this breakthrough has been cited as an example of successful global health diplomacy. This paper analyses this negotiation process, drawing on government documents, formal representations from both sides of the Taiwan Strait, and key informant interviews. The actors and their (...) motivations, along with the forums, practices and outcomes of the negotiation process, are detailed. While it is argued that non-traditional diplomatic action was important in establishing the case for Taiwan’s inclusion at the WHA, traditional concerns regarding Taiwanese sovereignty and diplomatic representation ultimately played a decisive role. The persistent influence of these traditional diplomatic questions illustrates the limits of global health diplomacy. (shrink)

Every day thousands of people die from poverty-related causes. Many of these deaths could be avoided if appropriate medical treatments were available to the world’s poor. Due to the current tructure of the international patent regime, they are not. Since the risks and costs associated with pharmaceutical innovation are extremely high, to incentivise research, inventor firms are granted a temporary monopoly over newly invented drugs. While allowing firms to make up for the costs of research, this has the morally (...) perverse effect of raising the prices of pharmaceuticals to a level where they become unaffordable to the world’s poor. To correct this grievous flaw, the paper proposes a concrete and realistic alternative scheme which, by rewarding medical innovators in proportion to the impact of their drugs on the global disease burden, would incentivise the production and selling of crucial drugs for the world’s poor at prices accessible to them. (shrink)

Every day thousands of people die from poverty-related causes. Many of these deaths could be avoided if appropriate medical treatments were available to the world’s poor. Due to the current tructure of the international patent regime, they are not. Since the risks and costs associated with pharmaceutical innovation are extremely high, to incentivise research, inventor firms are granted a temporary monopoly over newly invented drugs. While allowing firms to make up for the costs of research, this has the morally (...) perverse effect of raising the prices of pharmaceuticals to a level where they become unaffordable to the world’s poor. To correct this grievous flaw, the paper proposes a concrete and realistic alternative scheme which, by rewarding medical innovators in proportion to the impact of their drugs on the global disease burden, would incentivise the production and selling of crucial drugs for the world’s poor at prices accessible to them. (shrink)

Every day thousands of people die from poverty-related causes. Many of these deaths could be avoided if appropriate medical treatments were available to the world’s poor. Due to the current tructure of the international patent regime, they are not. Since the risks and costs associated with pharmaceutical innovation are extremely high, to incentivise research, inventor firms are granted a temporary monopoly over newly invented drugs. While allowing firms to make up for the costs of research, this has the morally (...) perverse effect of raising the prices of pharmaceuticals to a level where they become unaffordable to the world’s poor. To correct this grievous flaw, the paper proposes a concrete and realistic alternative scheme which, by rewarding medical innovators in proportion to the impact of their drugs on the global disease burden, would incentivise the production and selling of crucial drugs for the world’s poor at prices accessible to them. (shrink)

This book is a collection of fictionalized case studies of everyday ethical dilemmas and challenges, encountered in the process of conducting global health research in places where the effects of political and economic inequality are particularly evident. It is a training tool to fill the gap between research ethics guidelines and their implementation "on the ground." The cases focus on "relational" ethics: ethical actions and ideas that continuously emerge through relations with others, rather than being determined by bioethics regulation. (...) They are based on stories and experiences collected by a group of social anthropologists who have worked with leading transnational medical research organizations across Africa in the past decade. Accompanied by guidelines, discussion questions and selected further readings, the book provides a flexible resource for training and self-study for people engaged in health research with, universities, international collaborative sites and NGOs and for everyone interested in the realities of global health research today.". (shrink)

In this book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: what is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Daniels' theory has implications for national and global health policy: can we meet health needs fairly in ageing societies? Or protect health in (...) the workplace while respecting individual liberty? Or meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? Just Health: Meeting Health Needs Fairly explores the many ways that social justice is good for the health of populations in developed and developing countries. (shrink)

In confronting the insalubrious ramifications of globalization, human rights scholars and activists have argued for greater national and international responsibility pursuant to the human right to health. Codified seminally in Article 12 of the International Covenant on Economic, Social and Cultural Rights, the right to health proclaims that states bear an obligation to realize the “highest attainable standard” of health for all. However, in pressing for the highest attainable standard for each individual, the right to health (...) has been ineffective in compelling states to address burgeoning inequalities in underlying determinants of health, focusing on individual medical treatments at the expense of public health systems. This article contends that the paradigm of individual health, focused on a right to individual medical care, is incapable of responding to health inequities in a globalized world and thereby hampers efforts to operationalize health rights through public health systems. While the right to health has evolved in international discourse over time, this evolution of the individual right to health cannot address the harmful societal ramifications of economic globalization. Rather than relying solely upon an individual right to medical care, envisioning a collective right to public health – a right applied at the societal level to address underlying determinants of health – would alleviate many of the injurious health inequities of globalization. (shrink)

It is increasingly recognised that evidence generated using “real-world data” is crucial for assessing the safety and effectiveness of health-related interventions. This, however, raises a number of issues, including those related to the quality of RWD, and of the scientific methods used to generate evidence from it, and the potential for those gathering and using RWD be driven by commercial, political, professional or personal self-interest. This article is an application of the framework presented in this issue of ABR. (...) Please refer to that article for more information on how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end to demonstrate how those generating or using RWD can make use of values when deliberating about ethical issues. (shrink)

The right to health was codified in Article 12 of the International Covenant on Economic, Social and Cultural Rights as an individual right, focusing on individual health services at the expense of public health systems. This article assesses the ways in which the individual human right to health has evolved to meet collective threats to the public's health. Despite its repeated expansions, the individual right to health remains normatively incapable of addressing the injurious societal (...) ramifcations of economic globalization, advancing individual rights to alleviate collective inequalities in underlying determinants of health. By examining modern changes to underlying determinants of health, this article concludes that responding to globalized health threats necessitates a collective right to public health. (shrink)

The World Bank is committed to “work[ing] with countries to improve the health, nutrition and population outcomes of the world's poor, and to protect[ing] the population from the impoverishing effects of illness, malnutrition and high fertility”.1 Ethical issues arise in the interpretation of these objectives and in helping countries formulate strategies and policies. It is these ethical issues—which are often not acknowledged by commentators—that are the subject of this paper. It asks why there should be a focus (...) on the poor, and explores the link between improving the health of the poor, and reducing health inequalities between the poor and better-off. It discusses difficult ethical issues at both the global level and the country level. (shrink)

In this article, I explore some advantages of viewing well-being in terms of an individual's health status. Principally, I argue that this perspective makes it easier to establish that rich countries at least have an obligation to transfer 1 percent of their GDP to poor countries. If properly targeted at the fundamental determinants of health in developing countries, this transfer would very plausibly yield a disproportionate `bang for the buck' in terms of individual well-being. This helps to explain (...) how the obligation can be both light enough in its burden on the rich to avoid being `too demanding' and yet also bountiful enough in its effects to be worthy of the status of a `minimum obligation'. The advantages I enunciate are particularly relevant to establishing an obligation in the context of a non-ideal theory of international justice, which aims to set interim targets for practical action before an ideal theory has been settled. Key Words: health • international justice • foreign aid • determinants of health • non-ideal theory. (shrink)

The current U.S. health care system, with both rising costs and demands, is unsustainable. The combination of a sense of individual entitlement to health care and limited acceptance of individual responsibility with respect to personal health has contributed to a system which overspends and underperforms. This sense of entitlement has its roots in a perceived right to health care. Beginning with the so-called moral right to health care, the issue of who provides health care (...) has evolved as individual rights have trumped societal rights. The concept of government providing some level of health care ranges from limited government intervention, a ‘negative right to health care’, to various forms of a ‘positive right to health care’. The latter ranges from a decent minimum level of care to the best possible health care with access for all. We clarify the concept of legal rights as an entitlement to health care and present distributive and social justice counter arguments to present health care as a privilege that can be provided/earned/altered/revoked by governments. We propose that unlike a ‘right’, which is unconditional, a ‘privilege’ has limitations. Going forward, expectations about what will be made available should be lowered while taking personal responsibility for one’s health must for elevated. To have access to health care in the future will mean some loss of personal rights and an increase in personal responsibility for gaining or maintaining one’s health. (shrink)