This chapter contains sections titled: Introduction Doubts About Libertarianism Obligations Conclusions References Further reading.

The moral value of health : health as a basic human need -- The human right to health and its corresponding responsibilities -- States and natural persons as subjects of justice -- Pharmaceutical transnational corporations as subjects of justice -- The global health governance of the global health crisis.

The United Nations (UN) General Assembly High-Level Meeting (HLM) on pandemic prevention, preparedness and response (PPPR) was a missed opportunity to bring high-level commitment and momentum to the global governance of health emergencies. Intended to bring much-needed attention to a policy issue that is rapidly slipping down the international agenda, the fraught diplomacy among member states, lack of consensus on key issues, and weak UN Political Declaration in New York foreshadow a difficult road ahead for upcoming negotiations under (...) the World Health Organization (WHO) in Geneva. This column chronicles the evolving engagement of the UN in global health governance, examines the diplomatic process leading to the UN HLM on PPPR, and assesses the contributions and missed opportunities of its resulting Political Declaration. (shrink)

This is a pivotal moment in the global governance response to pandemic threats, with crucial global health law reforms being undertaken simultaneously in the coming years: the revision of the International Health Regulations, the implementation of the GHSA Legal Preparedness Action Package, and the negotiation of a new Pandemic Treaty. Rather than looking at these reforms in isolation, it will be necessary to examine how they fit together, considering: how these reforms can complement each other to (...) support pandemic prevention, preparedness, and response; what financing mechanisms are necessary to ensure sustainable health governance; and why vital norms of equity, social justice, and human rights must underpin this new global health system. (shrink)

While human rights law has evolved to provide guidance to governments in realizing human rights in public health emergencies, the COVID-19 pandemic has challenged the foundations of human rights in global health governance. Public health responses to the pandemic have undermined international human rights obligations to realize the rights to health and life, human rights that underlie public health, and international assistance and cooperation. As governments prepare for revisions of global health law, (...) new opportunities are presented to harmonize global health law and human rights law, strengthening rights-based governance to respond to future threats. (shrink)

In the coming weeks and months SARS-CoV-2 may ravage countries with weak health systems and populations disproportionately affected by HIV, tuberculosis, and other infectious diseases. Without safeguards and proper attention to global health equity and justice, the effects of this pandemic are likely to exacerbate existing health and socio-economic inequalities. This paper argues that achieving global health equity in the context of COVID-19 will require that notions of reciprocity and relational equity are introduced to (...) the response. (shrink)

There are several reasons for the current prominence of global health issues. Among the most important is the growing awareness that some risks to health are global in scope and can only be countered by global cooperation. In addition, human rights discourse and, more generally, the articulation of a coherent cosmopolitan ethical perspective that acknowledges the importance of all persons, regardless of where they live, provide a normative basis for taking global health seriously (...) as a moral issue. In this paper we begin the task of translating the vague commitment to doing something to improve global health into a coherent set of more determinate obligations. One chief conclusion of our inquiry is that the responsibilities of states regarding global health are both more determinate and more extensive than is usually assumed. We also argue, however, that institutional innovation will be needed to achieve a more comprehensive, fair distribution of concrete responsibilities regarding global health and to provide effective mechanisms for holding various state and nonstate actors accountable for fulfilling them. (shrink)

The problems of global health are truly terrible. Millions suffer and die from diseases like tuberculosis, HIV/AIDS, and malaria. One way of addressing these problems is via a Global Health Impact labeling campaign. If even a small percentage of consumers promote global health by purchasing Global Health Impact products, the incentive to use this label will be substantial. One might wonder, however, whether consumers are morally obligation to purchase any these goods or (...) whether doing so is even morally permissible. This paper suggests that if the proposal is implemented, purchasing Global Health Impact labelled goods is at least morally permissible, if not morally required. Its argument should, moreover, be of much more general interest to those considering different kinds of ethical consumption. (shrink)

Any system for the protection of intellectual property rights (IPRs) has three main kinds of distributive effects. It will determine or influence: (a) the types of objects that will be developed and for which IPRs will be sought; (b) the differential access various people will have to these objects; and (c) the distribution of the IPRs themselves among various actors. What this means to the area of pharmaceutical research is that many urgently needed medicines will not be developed at all, (...) that the existing medicines will not be suitable for countries with a precarious health infrastructure or not target the disease variety that is prevalent in poorer regions. Such effects are commonly captured under the rubric of the “10/90 gap” in biomedical research. High prices will also restrict access to medicines as well endanger compliance to treatment schemes. IPRs are mainly held by multinational corporations situated in the developed world, which not only raises egalitarian concerns, but also severely limits the possibilities of companies in poorer countries to realize improvements on existing inventions, as they cannot financially afford to secure freedom to operate, which systematically shrinks the number of potential innovators. Those inequities lead to an enormous burden for the global poor and since no institution is willing to assume the responsibility to fulfil the right to health and the corresponding right of access to essential medicines, we have to analyse alternatives or additions to the actual intellectual property regimes in order to create new incentives to fill this gap. (shrink)

Machine generated contents note: Preface; Introduction; Part I. Global Health, Definitions and Descriptions: 1. What is global health? Solly Benatar and Ross Upshur; 2. The state of global health in a radically unequal world: patterns and prospects Ron Labonte and Ted Schrecker; 3. Addressing the societal determinants of health: the key global health ethics imperative of our times Anne-Emmanuelle Birn; 4. Gender and global health: inequality and differences Lesley Doyal (...) and Sarah Payne; 5. Heath systems and health Martin McKee; Part II. Global Health Ethics, Responsibilities and Justice: Some Central Issues: 6. Is there a need for global health ethics? For and against David Hunter and Angus Dawson; 7. Justice, infectious disease and globalisation Michael Selgelid; 8. International health inequalities and global justice: toward a middle ground Norman Daniels; 9. The human right to health Jonathan Wolff; 10. Responsibility for global health? Allen Buchanan and Matt DeCamp; 11. Global health ethics: the rationale for mutual caring Solly Benatar, Abdallah Daar and Peter Singer; Part III. Analyzing Some Reasons for Poor Health: 12. Trade and health: the ethics of global rights, regulation and redistribution Meri Koivusalo; 13. Debt, structural adjustment and health Jeff Rudin and David Sanders; 14. The international arms trade and global health Salahaddin Mahmudi-Azer; 15. Allocating resources in humanitarian medicine Samia Hurst, Nathalie Mezger and Alex Mauron; 16. International aid and global health Anthony Zwi; 17. Climate change and health: risks and inequities Sharon Friel, Colin Butler and Anthony McMichael; 18. Animals, the environment and global health David Benatar; 19. The global crisis and global health Stephen Gill and Isabella Bakker; Part IV. Shaping the Future: 20. Health impact fund: how to make new medicines accessible to all Thomas Pogge; 21. Biotechnology and global health Hassan Masun, Justin Chakma and Abdallah Daar; 22. Food security and global health Lynn McIntyre and Krista Rondeau; 23. International taxation Gillian Brock; 24. Global health research: changing the agenda Tikki Pang; 25. Justice and research in developing countries Alex John London; 26. Values in global health governance Kearsley Stewart, Gerald T. Keusch and Arthur Kleinman; 27. Poverty, distance and two dimensions of ethics Jonathan Glover; 28. Teaching global health ethics James Dwyer; 29. Towards a new common sense: the need for new paradigms of global health Isabella Bakker and Stephen Gill; Index. (shrink)

For much of the 20th century, vulnerability to deprivations of health has often been defined by geographical and economic factors. Those in wealthy, usually ‘Northern’ and ‘Western’, parts of the world have benefited from infrastructures, and accidents of geography and climate, which insulate them from many serious threats to health. Conversely, poorer people are typically exposed to more threats to health, and have lesser access to the infrastructures needed to safeguard them against the worst consequences of such (...) exposure. However, in recent years the increasingly globalized nature of the world’s economy, society and culture, combined with anthropogenic climate change and the evolution of antibiotic resistance, has begun to shift the boundaries that previously defined the categories of person threatened by many exogenous threats to health. In doing so, these factors expose both new and forgotten similarities between persons, and highlight the need for global cooperative responses to the existential threats posed by climate change and the evolution of antimicrobial resistance. In this article, we argue that these emerging health threats, in demonstrating the similarities that exist between even distant persons, provides a catalyst for global solidarity, which justifies, and provides motivation for, the establishment of solidaristic, cooperative global health infrastructures. (shrink)

Following from sweeping law reforms across the global health landscape, there is a need to prepare the next generation to advance global health law to ensure justice for a healthier world. Educational programs across disciplines have increasingly incorporated the field of global health law, with new courses examining the law and policy frameworks that apply to the new set of public health threats, non-state actors, and regulatory instruments that structure global health. (...) Such interdisciplinary training must be expanded throughout the world to prepare future practitioners to strengthen global health law — ensuring a foundation for global health in legal studies and law and global health studies. Meeting this imperative for global health law teaching — establishing academic courses and textbooks on global legal responses to shared health threats — will be necessary to support students to address the global health challenges of the future. (shrink)

Thomas Pogge has included responsibilities for global health at the core of his liberal agenda and has urged corresponding, efficient reforms in practice. The current article focuses on his proposal for establishing a global fund for the development and delivery of essential medicines for the poor. It is argued that while Pogge interestingly attempts to harness both moral and non-moral human resources to serve global health, the efficiency of his proposed fund is not evident. (...) First, its internal logic implies that part of valuable development aid would end up as profit for drug corporations. Hence, the corporations should be able to utilise the other part of the public funding remarkably efficiently. Second, several existing programmes for global health (such as the Global Fund to Fight AIDS, Malaria and Tuberculosis) have achieved significant results. This provides them with a firm basis for applying for additional funding. In accordance with the United Nations Millennium Development Goals, the plea for additional funding for global health seems overwhelmingly justified; in order to coordinate its use efficiently, a significant degree of public management is needed. (shrink)

The field of bioethics has evolved over the past half-century, incorporating new domains of inquiry that signal developments in health research, clinical practice, public health in its broadest sense and more recently sensitivity to the interdependence of global health and the environment. These extensions of the reach of bioethics are a welcome response to the growth of global health as a field of vital interest and activity. This paper provides a critical interpretive review of (...) how the term “global health ethics” has been used and defined in the literature to date to identify ethical issues that arise and need to be addressed when deliberating on and working to improve the discourse on ethical issues in health globally. Selected publications were analyzed by year of publication and geographical distribution, journal and field, level of engagement, and ethical framework. Of the literature selected, 151 articles were written by authors in high-income countries, as defined by the World Bank country classifications, 8 articles were written by authors in low- or middle-income countries, and 13 articles were collaborations between authors in HIC and LMIC. All of the articles selected except one from 1977 were published after 1998. Literature on global health ethics spiked considerably from the early 2000s, with the highest number in 2011. One hundred twenty-seven articles identified were published in academic journals, 1 document was an official training document, and 44 were chapters in published books. The dominant journals were the American Journal of Bioethics, Developing World Bioethics, and Bioethics. We coded the articles by level of engagement within the ethical domain at different levels: interpersonal, institutional, international, and structural. The ethical frameworks at use corresponded to four functional categories: those examining practical or narrowly applied ethical questions; those concerned with normative ethics; those examining an issue through a single philosophical tradition; and those comparing and contrasting insights from multiple ethical frameworks. This critical interpretive review is intended to delineate the current contours and revitalize the conversation around the future charge of global health ethics scholarship. (shrink)

The field of bioethics has evolved over the past half-century, incorporating new domains of inquiry that signal developments in health research, clinical practice, public health in its broadest sense and more recently sensitivity to the interdependence of global health and the environment. These extensions of the reach of bioethics are a welcome response to the growth of global health as a field of vital interest and activity. This paper provides a critical interpretive review of (...) how the term “global health ethics” has been used and defined in the literature to date to identify ethical issues that arise and need to be addressed when deliberating on and working to improve the discourse on ethical issues in health globally. Selected publications were analyzed by year of publication and geographical distribution, journal and field, level of engagement, and ethical framework. Of the literature selected, 151 articles were written by authors in high-income countries, as defined by the World Bank country classifications, 8 articles were written by authors in low- or middle-income countries, and 13 articles were collaborations between authors in HIC and LMIC. All of the articles selected except one from 1977 were published after 1998. Literature on global health ethics spiked considerably from the early 2000s, with the highest number in 2011. One hundred twenty-seven articles identified were published in academic journals, 1 document was an official training document, and 44 were chapters in published books. The dominant journals were the American Journal of Bioethics, Developing World Bioethics, and Bioethics. We coded the articles by level of engagement within the ethical domain at different levels: interpersonal, institutional, international, and structural. The ethical frameworks at use corresponded to four functional categories: those examining practical or narrowly applied ethical questions; those concerned with normative ethics; those examining an issue through a single philosophical tradition; and those comparing and contrasting insights from multiple ethical frameworks. This critical interpretive review is intended to delineate the current contours and revitalize the conversation around the future charge of global health ethics scholarship. (shrink)

We are in the midst of a crisis of climate change and environmental degradation that will only get worse, unless significant changes are rapidly made. Globally, the healthcare sector causes a large share of our total environmental footprint: 4.4% of greenhouse gases. Sustainable healthcare has emerged as a way for healthcare sectors in high‐income countries to help mitigate climate change by reducing their emissions. Whether global health should be sustainable and what ethical grounds might exist to support such (...) a claim are not questions that have been investigated. The paper argues that global health practice—the delivery of health services to underserved populations in resource‐poor areas of the world—should be sustainable as a matter of climate justice and solidarity. Reducing climate change‐related risks and harms for the vulnerable is integral to the mission of global health and thus it is necessary to consider the climate impact of its practice. The field has a duty to provide sustainable health services that are responsive to climate change‐related changes in the local burden of disease and to build sustainable health system infrastructure. Specific responsibilities for global health funders, managers, and implementers to uphold the duty are proposed. To conclude, the paper considers what limits might be placed on the duty to deliver sustainable global healthcare. (shrink)

What are the respective roles and responsibilities of global, national, and local communities as well as individuals themselves to address health deprivations and avert health threats? This article offers the beginnings of a theory of global health justice, arguing for universal ethical norms (general duty) with shared global and domestic responsibility (specific duties) for health. It offers a global minimalist view I call ‘ provincial globalism ’ as a mean between nationalism (...) and cosmopolitanism, in which a provincial consensus must accompany a global consensus on health morality. This minimalist account asserts global and national duties to promote human flourishing and, more specifically, individuals’ central health capabilities. In this view, justice requires prioritizing responsibilities through shared health governance to reduce shortfall inequalities in central health capabilities — a general duty to reduce premature mortality and escapable morbidity. It examines the difficulties presented by the philosophical principles of connectedness, causality, remediation, partiality, and capacity in the allocation of responsibility for global health. It offers a theory of responsibility allocation based on a functional, health agency centered and homeostatic balanced understanding of the analytical components required to solve global health problems and parcels out roles and responsibilities at the global, national, local, and individual levels accordingly. Allocations of responsibility rest on the effectiveness and special obligations of different actors, respecting self-determination by groups and individuals and seeking voluntary commitments . This view understands that the remedy for global health problems must be sustainable to take nations and the global health community to a new global health equilibrium that remedies current problems and prepares for new health threats to come. (shrink)

In 2013, one year after the enactment of the landmark Mental Health Act, a small team of psychiatrists, psychologists, and statisticians from the University of Ghana Medical School began a controversial field-based randomized-control trial entitled "Joining Forces" at the Mount Horeb prayer camp. Located about 45 minutes outside of Accra, Mt. Horeb is one of the largest and best known prayer camps in Ghana. It is an Evangelical Pentecostal organization whose mission is to "set free those held captive by (...) Satan through a ministry of fasting and prayer". Mount Horeb had a well-documented track record of human... (shrink)

Background The field of bioethics has evolved over the past half-century, incorporating new domains of inquiry that signal developments in health research, clinical practice, public health in its broadest sense and more recently sensitivity to the interdependence of global health and the environment. These extensions of the reach of bioethics are a welcome response to the growth of global health as a field of vital interest and activity. Methods This paper provides a critical interpretive (...) review of how the term “global health ethics” has been used and defined in the literature to date to identify ethical issues that arise and need to be addressed when deliberating on and working to improve the discourse on ethical issues in health globally. Results Selected publications were analyzed by year of publication and geographical distribution, journal and field, level of engagement, and ethical framework. Of the literature selected, 151 articles were written by authors in high-income countries, as defined by the World Bank country classifications, 8 articles were written by authors in low- or middle-income countries, and 13 articles were collaborations between authors in HIC and LMIC. All of the articles selected except one from 1977 were published after 1998. Literature on global health ethics spiked considerably from the early 2000s, with the highest number in 2011. One hundred twenty-seven articles identified were published in academic journals, 1 document was an official training document, and 44 were chapters in published books. The dominant journals were the American Journal of Bioethics, Developing World Bioethics, and Bioethics. We coded the articles by level of engagement within the ethical domain at different levels: interpersonal, institutional, international, and structural. The ethical frameworks at use corresponded to four functional categories: those examining practical or narrowly applied ethical questions; those concerned with normative ethics; those examining an issue through a single philosophical tradition; and those comparing and contrasting insights from multiple ethical frameworks. Conclusions This critical interpretive review is intended to delineate the current contours and revitalize the conversation around the future charge of global health ethics scholarship. (shrink)

The Covid-19 pandemic has dramatically shown the level of interconnectedness of the human population, the direct relation between human health and the ecosystem, as well as the enormous ethical challenges required for a global response. Relatedly, society has been directly confronted by issues of ‘Global health,’ both in terms of awareness of health conditions and health systems resiliency all around the world, as well as in terms of governance of the worldwide response and its (...) implications at national and local levels. While Global health is often used as a cosmetic label for neocolonial approaches, it is really an interdisciplinary approach consisting of the interaction between globalization and the determinants of health. Thus, it involves the ecosystem and its transformation and implies a systemic ‘One Health’ decolonized approach in the definition of its strategies. The Covid-19 pandemic has highlighted the inequities and the limits of the current hegemonic Global health system governance; calling for ethics to provide a renewed, comprehensive, inclusive, and decolonized conceptualization of Global health. (shrink)

Why should we care about global health? What obligations do we have to improve global health? How can we work towards establishing a health industry that is better equipped to deal with the most significant global health challenges? In her impressive and ambitious book, Global Health Impact: Extending Access to Essential Medicine (Hassoun, 2020), Nicole Hassoun attempts to answer these questions, by drawing on contemporary research in political philosophy, global justice, (...) health economics and business ethics. In this symposium, Timothy Campbell, Yukiko Asada and Andreas Albertsen explore three dimensions of Hassoun’s proposal: the relation between measuring global health impact and conceptions of the minimally good life, different metrics used to measure the global health burden and democratic consumption and social justice. In a response paper, Hassoun responds to the critical remarks.In her book, Hassoun presents a theoretical framework that explains why we ought to care about global health, develops a way of measuring the global health impact of health technologies and argues that individuals should be guided by this in their consumption. The book presents an ambitious proposal for how one in a very practical way can use the measuring tool in order to promote global health by labeling and certifying different market products so that consumers and investors get incentivizing information that can change their behavior in a way that promotes global health. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Global Health Careers:Serving the Navajo CommunityMaricruz Merino, Jonathan Iralu, and Sonya ShinGallup Indian Medical Center (GIMC) sits on a hilltop in Gallup, New Mexico, a town of 20,000 in the four corners region of the Southwestern United States. From its third story windows one can see the red cliffs of the nearby Navajo Nation, a 27,000 square mile reservation that reaches into Arizona, northern New Mexico, and (...) the southern edges of Utah. It is a vast, rural landscape that houses more than 350,000 Navajos. For many on the reservation, healthcare is provided by Indian Health Service hospitals such as GIMC."Are you going to stay?" is a common question for new doctors at GIMC. The Navajo know that their geographic location, while beautiful and attractive to many young providers, will also be the reason they leave. It is hard for doctors to be away from their own homelands. Aging parents get sick, [End Page 86] educational opportunities arise, and children who need to be near extended family are born. But to the Navajo, the story of an individual provider is not so important or memorable. All they know is that providers come and go."Are you here to experiment on us?" is yet another question. Years of exploitation and efforts to destroy traditional ways and language have made many Navajo wary of healthcare providers, no matter how genuine their intentions. Many are so fearful of the hospital—they regard it as "the place to go die."Yet despite this initial suspicion, the Navajo are welcoming people at heart, and tend to develop relationships of trust with their providers. Parents will begin to talk about their grief over a son that has committed suicide or a daughter who died from alcoholic cirrhosis. The elderly will tell you how they care for their five orphaned grandchildren while they can barely take care of their own diabetes. A carpenter tells you he has not worked in a year and feels worthless. An HIV-positive woman will tell you she has been sleeping in a dry river bed because she has no place to go. It quickly becomes apparent that as a physician you will be treating patients with enormous social challenges in addition to complex medical conditions.The origins of the Federal Government's involvement in the healthcare of American Indians and Alaskan Natives (AI/ANs) in the 19th century arose out of both legal obligation and concern for self- preservation. Health services were promised to AI/ ANs in exchange for land, settlements, and agreements. In addition, infectious diseases endemic on reservations as a consequence of crowding and abject poverty, including smallpox and tuberculosis, were seen as a major public health concern. The responsibility of Native American health was first granted to the War Department, then to the Bureau of Indian Affairs, and finally to the Public Health Service in 1955 under the heading of the IHS, or Indian Health Service (U.S. Commission on Civil Rights, 2004; National Library of Medicine, 1994).Since then, the IHS has had many successes. Vaccination rates have gone up, and rates of pneumonia and tuberculosis have gone down significantly. Maternal and infant mortality have declined, and life expectancy has increased (Indian Health Services, 1999). Nonetheless, these improvements remain overshadowed by glaring health disparities among AI/ANs across a broad spectrum of diseases, both communicable and non-communicable, acute and chronic. Native Americans experience higher rates of obesity, diabetes, and cardiovascular disease than the general United States population. They are also more likely to die from alcohol-related causes and in accidents. Life expectancy remains more than five years less than that of the general U.S. population (U.S. Commission on Civil Rights, 2004; U.S. Department of Health and Human Services, 2000).Underlying these health indicators is the continued impoverished status of most AI/ANs. In Navajo, almost half of the population lives below the poverty line. According to the Navajo Nation, the current unemployment rate is 42% (Navajo Nation Department of Economic Development, 2011). Many Navajo on the reservation do not have running water or electricity. They heat with wood, which they chop and haul themselves—regardless... (shrink)

ABSTRACT: BACKGROUND: The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and (...) public debate on donor responsibilities for global health. METHODS: We undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. RESULTS: Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. CONCLUSIONS: Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen collective action. (shrink)

The conventional approach to international development by civil society—that is, the installation of “Western” programs and institutions by “Western” groups in “underdeveloped” regions—has remained largely unchanged since global poverty reduction, whether for political or social justice motivations, gained prominence in public discourse after World War II. Yet poverty rates, literacy, life expectancy, and unemployment in one of the poorest regions of the world, sub-Saharan Africa, has remained the same if not worsened since the 1970s . And, still, the great (...) Development Project continues: Problems in under-resourced areas are identified by well-meaning people from well-resourced areas, proposals to solve those problems are crafted by project managers and submitted to government and nongovernmental agencies, and successful projects are implemented by other well-meaning people who, for the most part, honestly want to make a difference. This is the system in which Priya seems to .. (shrink)

While there is a growing body of work on moral issues and global governance in the fields of global justice and international relations, little work has connected principles of global health justice with those of global health governance for a theory of global health. Such a theory would enable analysis and evaluation of the current global health system and would ethically and empirically ground proposals for reforming it to more closely (...) align with moral values. Global health governance has been framed as an issue of national security, human security, human rights, and global public goods. The global health governance literature is essentially untethered to a theorized framework to illuminate or evaluate governance. This article ties global health justice and ethics to principles for governing the global health realm, developing a theoretical framework for global and domestic institutions and actors. (shrink)

This chapter critically explores the extent to which pharmaceutical companies have a moral obligation to assist poor patients in least developed countries who currently have no or inadequate access to lifesaving medications. Focusing on the ongoing HIV/AIDS epidemic in LDCs, the first section of this essay begins with some background information of the disproportionate burden of HIV/AIDS in LDCs. The second section provides a brief overview of some of the salient arguments for holding multinational antiretroviral treatment manufacturers as morally responsible (...) for easing the disproportionate global disease burden. The third section explains that these arguments regarding pharmaceutical companies’ duty to assist are going too far on the one hand by downplaying other non-pharmacological contributors to the slow response, but are also not going far enough on the other hand in upholding reciprocity-based duties. As the international community and researchers battle the reemergence of Ebola in Africa, the fourth section explores how lessons from the HIV/AIDS situation can help to address what pharmaceutical companies may subsequently owe patients in this region and how the international community should respond to ongoing unequal disease burden. (shrink)

Over the past two decades, the promotion of collaborative partnerships involving researchers from low and middle income countries with those from high income countries has been a major development in global health research. Ideally, these partnerships would lead to more equitable collaboration including the sharing of research responsibilities and rewards. While collaborative partnership initiatives have shown promise and attracted growing interest, there has been little scholarly debate regarding the fair distribution of authorship credit within these partnerships.

Global governance of emerging, disruptive biomedical technologies presents a multitude of ethical problems. The recent paper by Shoziet alraises some of these problems in the context of a discussion of what could be themostdisruptive (and most morally fraught) emerging biomedical technology—human germline genome editing. At the heart of their argument is the claim that, for something like gene editing, there is likely to be tension between the interests of specific states in crafting regulation for the technology, and disagreement about (...) what would be necessary to meet the requirements for responsible translation of gene editing into the clinic. This complicates hopes for a tidy, algorithmic process of crafting global governance via frameworks for regulation built around core ‘ethical values and principles’ (as they are called in the WHO Framework), and also forces us to confront deeper philosophical questions about biotechnology and global health. (shrink)

The central role of Health Care Analysis is to advance discourses between philosophy, health, and policy. Within that very wide-ranging agenda, perhaps the most complex challenges are in global health. In countries across the world, many, many populations are unable to enjoy conditions in which they can be healthy. The barriers to change are political, economic, social, regulatory, legal, and philosophical. Lawrence Gostin’s recent book on Global Health Law therefore marks a contribution of the (...) highest importance, marrying practical and philosophical agendas, and aiming at achieving global health with justice. -/- To progress the important work of Gostin’s book, the current journal issue draws together leading scholars in moral and political philosophy, economics, and law, with a shared interest in questions of global justice. In the first paper, Eric Friedman and Lawrence Gostin provide a clear overview of the practical and theoretical global health challenges and their response to these. Their analysis is followed by stimulating contributions from Norman Daniels, Jennifer Prah Ruger, Shawn Harmon, Attiya Waris and Laila Abdul Latif, Heather Widdows, and A.M. Viens, each engaging with questions raised by Global Health Law. The different papers underscore the significance of this area of inquiry, and the imperative to bring insights from scholarly work into global health practice. (shrink)

Medical student and resident participation in global health experiences (GHEs) has significantly increased over the last decade. In response to growing student interest and the proven impact of such experiences on the education and career decisions of resident physicians, many medical schools have begun to establish programmes dedicated to global health education. For the innumerable benefits of GHEs, it is important to note that medical students have the potential to do more harm than good in these (...) settings when they exceed their actual capabilities as physicians-in-training. While medical training programmes are beginning to provide students with the knowledge to put their GHEs in context, they must remember that they also bear the responsibility of training their students in a framework to approach these experiences in a principled and professional way. It is necessary that these institutions provide adequate and formalised preparation for both clinical and ethical challenges of working in resource-poor settings. This paper outlines potential benefits and risks of GHEs and delineates recommendations to some of the current issues. (shrink)

In response to commentators, we argue that whether waiving patent rights will meaningfully improve access to COVID-19 vaccines for low income and middle-income countries (LMICs), particularly in the short term, is an empirical matter. We also reject preferentially allocating vaccines to countries that hosted trials because doing so unethically favours those with research infrastructure, rather than those facing the worst burdens from COVID-19.

Global health is a concept which in recent years has evoked a lot of interest from both academics, politicians, celebrities, and the media. The term “global health” implies a globally shared responsibility to provide health as a public good through an expansive number of initiatives. This emerging era of consciousness about our international interdependence, regardless of a problem’s geographic location or type of disease, may be a good moment for exploring the strengths and weaknesses of (...) an international law approach to global health challenges: a global health convention.The most prominent global health initiatives are the Millennium Development Goals, the 2005 Paris Declaration Process on Aid Effectiveness on the need for alignment and coordination, and the 2008 Accra High Level Forum on Aid Effectiveness. These instruments have yet to prove their value, and the funds annually disbursed, approximately $25 billion in 2009, could have better effect if the negotiated principles from the PDP and the AHLF were followed. (shrink)

This paper considers how we can conceptualize a “global response” to chronic, non-communicable diseases (NCDs) – including cardiovascular disease, cancer, diabetes, and tobacco-related diseases. These diseases are the leading cause of death and disability in developed countries, and also in developing countries outside sub-Saharan Africa. The paper reviews emerging and proposed initiatives for global NCD governance, explains why NCDs merit a global response, and the ways in which global initiatives ultimately benefit national health outcomes. As (...) the global response to NCDs matures, and the number of initiatives and partnerships increases, it will become increasingly important to map their respective contributions, and to evaluate progress overall. It is not yet clear what institutional mechanism, if any, will rise above the sea of surrounding initiatives to play this global role. This paper therefore aims to provide a conceptual map for making sense of what individual initiatives contribute to global governance. This map also draws attention to the distinctively “global” public health functions that a global response to NCDs should seek to discharge. (shrink)

The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced and 26.4 million registered refugees. The ongoing conflict in Syria is a major contributor. After a decade of violence and destabilization, over 13.4million Syrians have been displaced, including 6.7 million internally displaced persons and 6.7 million refugees registered in other countries. Beyond the immediate political and economic challenges, an essential component of any response to this humanitarian crisis must be health-related, including policies and (...) interventions specific to mental health. This policy and practice review addresses refugee mental health in the context of the Syrian crisis, providing an update and overview of the current situation while exploring new initiatives in mental health research and global health policy that can help strengthen and expand services. Relevant global health policy frameworks are first briefly introduced, followed by a short summary of recent research on refugee mental health. We then provide an update on the current status of research, service provision, and health policy in the leading destinations for Syrians who have been forcibly displaced. This starts within Syria and then turns to Turkey, Lebanon, Jordan, and Germany. Finally, several general recommendations are discussed, including the pressing need for more data at each phase of migration, the expansion of integrated mental health services, and the explicit inclusion and prioritization of refugee mental health in national and global health policy. (shrink)

The most common response to the challenge of protecting health through law is to focus on protecting the rights of vulnerable individuals and to enhance their access to health care. Each one of us is vulnerable or potentially vulnerable because of the fragile, existential nature of the human condition. Catastrophic and unexpected events could instantaneously transform us from a state of total independence and potential vulnerability to one of extreme vulnerability and complete dependence. Some legal provisions have the (...) potential to provide a modicum of protection when we find ourselves in those situations. There are also legal provisions that contribute to beneficial social circumstances; for example, legislation enabling universal access to medical care, and operationalizing respect for the individual’s right to health care, as advocated for by other authors in this issue. (shrink)

The recent outbreak of Ebola in West Africa has killed thousands of people, including healthcare workers. African responses have been varied and largely ineffective. The WHO and the international community’s belated responses have yet to quell the epidemic. The crisis is characteristic of a failure to properly comply with the International Health Regulations 2005. More generally, it stems from a failure of international health justice as articulated by a range of legal institutions and instruments, and it should prompt (...) us to question the state and direction of approaches to the governance of global public health. This paper queries what might be done to lift global public health as a policy arena to the place of prominence that it deserves. It argues that there are at least two critical reasons for the past, present and easily anticipated future failings of the global public health regime. After exploring those, it then articulates a new way forward, identifying three courses of action that might be adopted in realising better health outcomes and global health justice, namely value, institutional and legal reform. (shrink)

Global health and environmental wellbeing are mutually reinforcing and interdependent. This mutuality invokes two major analytical orientations: it emphasizes a direct nexus between ecological strategies and global health outcomes. These in turn revitalize the essential quest for comprehensive policies and responsible strategies for enhancing both ecology and health within the discourse of sustainability. With orientation towards political conception of corporate responsibility, I problematize the root questions of the democratic embeddedness of the firm under conditions of (...) weakened institutional structures. I highlight the inherent power relations in global health and ecological governance through literature mapping. I address the question: Why and how might ecological strategies be embedded in corporate day-to-day actions to produce optimal outcomes that have positive effects on global health and human dignity? Besides resource and ethical/political constraints, there are several micro-political, geopolitical, industrial, institutional and structural impediments to ecological and health sustainability. This grim diagnosis is clearly a description of a ‘disturbingly fascinating’ pathology of global capitalism whose industrial effects culminate in the accumulation of more profits for a few at the expense of the ecological sustainability of the majority. That notwithstanding, there are several grounds for optimism with a move from anthropocentrism to humanistic eco-centrism via deliberative democratic procedures. Here, the centrality of human dignity is emphasized. This study provides an interdisciplinary theoretical model that seeks to reorient strategies towards restoration, protection, mitigation, adaptation, harm avoidance and innovative sustainability of the whole economic gamut and biodiversity that supports global health. Thus, I rearticulate ecological sustainability in terms of its most fundamental means and end: sustainable global health and the tutelage of human dignity. (shrink)

BackgroundCommunity engagement in research has gained momentum as an approach to improving research, to helping ensure that community concerns are taken into account, and to informing ethical decision-making when research is conducted in contexts of vulnerability. However, guidelines and scholarship regarding community engagement are arguably unsettled, making it difficult to implement and evaluate.DiscussionWe describe normative guidelines on community engagement that have been offered by national and international bodies in the context of HIV-related research, which set the stage for similar work (...) in other health related research. Next, we review the scholarly literature regarding community engagement, outlining the diverse ethical goals ascribed to it. We then discuss practical guidelines that have been issued regarding community engagement. There is a lack of consensus regarding the ethical goals and approaches for community engagement, and an associated lack of indicators and metrics for evaluating success in achieving stated goals. To address these gaps we outline a framework for developing indicators for evaluating the contribution of community engagement to ethical goals in health research.SummaryThere is a critical need to enhance efforts in evaluating community engagement to ensure that the work on the ground reflects the intentions expressed in the guidelines, and to investigate the contribution of specific community engagement practices for making research responsive to community needs and concerns. Evaluation mechanisms should be built into community engagement practices to guide best practices in community engagement and their replication across diverse health research settings. (shrink)

The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next infectious disease outbreak and what we owe to people in other countries during normal times. While the prevailing bioethics literature addresses these questions drawing on values and concepts prominent in the global north, this paper articulates responses prominent (...) in sub-Saharan Africa. The paper first introduces a figurative ‘global health village’ to orient readers to African traditional thought. Next, it considers ethical requirements for governing a global health village, drawing on the ethic of ubuntu to formulate African renderings of solidarity, relational justice and sufficiency. The final section of the paper uses these values to critique current approaches, including COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) accelerator, and a proposed international Pandemic Treaty. It proposes a path forward that better realizes ubuntu in global health. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 65, July 2012.

Volume 20, Issue 8, August 2020, Page W14-W16.

BackgroundA recent paper presents an argument and mechanism for the possible stopping of clinical trials early based on opportunity costs.DiscussionAlthough we agree that the costs and opportunity costs of clinical trials need to be reduced wherever possible, we raise concerns about the motivation and mechanism for stopping clinical trials early raised by Lavery et al.SummaryWe argue that there are already enough acceptable criteria and actors in the clinical trials arena to justify early stoppage of clinical trials, and argue that factors (...) other than efficacy need to be carefully considered, especially in developing country contexts. (shrink)