Volume 24, Issue 10, October 2024, Page 101-103.

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)

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.

Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap. National and international decision-makers face tough choices about how scarce (...) health care resources should be spent. Should additional funds be spent on primary prevention of stroke, treating childhood cancer, or expanding treatment for HIV/AIDS? Should health coverage decisions take into account the effects of illness on productivity, household finances, and children's educational attainment, or just focus on health outcomes? Does age matter for priority setting or should it be ignored? Are health gains far in the future less important than gains in the present? Should higher priority be given to people who are sicker or poorer? Global Health Priority-Setting provides a framework for how to think about evidence-based priority-setting in health. Over 18 chapters, ethicists, philosophers, economists, policy-makers, and clinicians from around the world assess the state of current practice in national and global priority setting, describe new tools and methodologies to address establishing global health priorities, and tackle the most important ethical questions that decision-makers must consider in allocating health resources. (shrink)

Although the world has experienced remarkable progress in health care since the last half of the 20th century, global health inequalities still persist. In some poor countries life expectancy is between 37-40 years lower than in rich countries; furthermore, maternal and infant mortality is high and there is lack of access to basic preventive and life-saving medicines, as well a high prevalence of neglected diseases, HIV/AIDS, tuberculosis, and malaria. Moreover, globalization has made the world more connected than (...) before such that health challenges today are no longer limited within national or regional boundaries, making all persons equally vulnerable. Because of this, diseases in the most affluent countries are closely connected with diseases in the poorest countries. In this paper, we argue that, because of global health inequalities, in a situation of equal vulnerability, there is need for global solidarity not only as a means of reducing health inequalities, but also as a way of putting up a united force against global health challenges. We argue for an African approach to solidarity in which the humanity of a person is not determined by his/her being human or rational capacity, but by his/her capacity to live a virtuous life. According to this view of solidarity, because no one is self-sufficient, no individual can survive alone. If we are to collectively flourish in a world where no individual, nation or region has all the health resources or protection needed for survival, we must engage in solidarity where we remain compassionate and available to one another at all times. (shrink)

Developing Global Health Programming: A Guidebook for Medical and Professional Schools , edited by Jessica Evert, Paul Drain, and Thomas Hall, is reviewed. In spite of some editorial shortcomings, the book is a terrific aggregation of resources and reflections on the state of global health education that leaves readers with a multitude of useful and diverse tools, as well as directions about where to find additional ones.

Global health security in the Biden-Harris Administration has been a dynamic area of engagement, starting with the COVID-19 response, to strengthening and reforming the World Health Organization, to bolstering regional partnerships, and securing financing for pandemic preparedness. Sustained commitment to bilateral, regional, and multilateral cooperation will ensure that the United States stands ready to address any future health challenges.

McDonough Hall, Room 508, 600 New Jersey Ave, NW, Washington, DC 20001, USA; Email: gostin{at}law.georgetown.edu ' + u + '@' + d + ' '//--> Abstract As a consequence of rapid globalization, the need for a coherent system of global health law and governance has never been greater. This article explores the health hazards posed by contemporary globalization on human health and the consequent urgent need for global health law to facilitate effective multilateral cooperation (...) in advancing the health of populations equitably. It sets forth the first definition of the emerging field of "global health law." After explicating the central features identified in the definition, the article examines the "grand challenges" to reaching the full potential of global health law to advance human health in just and effective ways. CiteULike Connotea Del.icio.us What's this? (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)

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)

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)

Nicole Hassoun here makes a philosophical argument for health, and access to essential medicines, as essential human rights, and she proposes the Global Health Impact system as a way to ensure those rights. She reports how life-saving medicines are inaccessible and costly for the global poor, and that rather than focusing on treatments for critical, deadly global health problems, pharmaceutical companies instead invest in more profitable drugs. To address this problem, Hassoun's proposal will rate (...) pharmaceutical companies based on their medicines' impact on the improvement of global health, and will reward highly-rated medicines with a Global Health Impact label. (shrink)

The singular message in Global Health Law is that we must strive to achieve global health with justice—improved population health, with a fairer distribution of benefits of good health. Global health entails ensuring the conditions of good health—public health, universal health coverage, and the social determinants of health—while justice requires closing today’s vast domestic and global health inequities. These conditions for good health should be incorporated (...) into public policy, supplemented by specific actions to overcome barriers to equity. A new global health treaty grounded in the right to health and aimed at health equity—a Framework Convention on Global Health —stands out for its possibilities in helping to achieve global health with justice. This far-reaching legal instrument would establish minimum standards for universal health coverage and public health measures, with an accompanying national and international financing framework, require a constant focus on health equity, promote Health in All Policies and global governance for health, and advance the principles of good governance, including accountability. While achieving an FCGH is certainly ambitious, it is a struggle worth the efforts of us all. The treaty’s basis in the right to health, which has been agreed to by all governments, has powerful potential to form the foundation of global governance for health. From interpretations of UN treaty bodies to judgments of national courts, the right to health is now sufficiently articulated to serve this role, with the individual’s right to health best understood as a function of a social, political, and economic environment aimed at equity. However great the political challenge of securing state agreement to the FCGH, it is possible. States have joined other treaties with significant resource requirements and limitations on their sovereignty without significant reciprocal benefits from other states, while important state interests would benefit from the FCGH. And from integrating the FCGH into the existing human rights system to creative forms of compliance and enforcement and strengthened domestic legal and political accountability mechanisms, the treaty stands to improve right to health compliance. The potential for the FCGH to bring the right to health nearer universal reality calls for us to embark on the journey towards securing this global treaty. (shrink)

This paper reflects on Lawrence Gostin’s Global Health Law. In so doing seeks to contribute to the debate about how global health justice is best conceived and achieved. Gostin’s vision of global health is one which is communal and in which health is directly connected to other justice concerns. Hence the need for health-in-all policies, and the importance of focusing on basic and communal health goods rather than high-tech and individual ones. (...) This paper asks whether this broadly communal vision of global health justice is best served by making the right to health central to the project. It explores a number of reasons why rights-talk might be problematic in the context of health justice; namely, structurally, rights are individual and state-centric and politically, they are oppositional and better suited to single-issue campaigns. The paper argues that stripping rights of their individualist assumptions is difficult, and perhaps impossible, and hence alternative approaches, such as those Gostin endorses based on global public goods and health security, might deliver much, perhaps most, global health goods, while avoiding the problems of rights-talk. (shrink)

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

Global health research partnerships are increasingly taking the form of consortia of institutions from high-income countries and low- and middle-income countries that undertake programs of research. These partnerships differ from collaborations that carry out single projects in the multiplicity of their goals, scope of their activities, and nature of their management. Although such consortia typically aim to reduce health disparities between and within countries, what is required for them to do so has not been clearly defined. This (...) article takes a conceptual approach to explore how the governance of transnational global health research consortia should be structured to advance health equity. To do so, it applies an account called shared health governance to derive procedural and substantive guidance. A checklist based on this guidance is proposed to assist research consortia determine where their governance practices strongly promote equity and where they may fall short. (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)

Henry Shue’s model of basic rights and their correlative duties provides an excellent framework for analysing the requirements of global distributive justice, and for theorising about the minimum acceptable standards of human entitlement and wellbeing. Shue bases his model on the claim that certain ‘basic’ rights are of universal instrumental value, and are necessary for the enjoyment of any other rights, and of any ‘decent life’. Shue’s model provides a comprehensive argument about the importance of certain fundamental goods for (...) all human lives, though he does not consider health or health care in any significant detail. Adopting Shue’s model, I argue that access to health care is of sufficient importance to the enjoyment of any other rights that it qualifies as what Shue describes as a ‘basic’ right. I also argue that the basic right to health care is compatible with the basic rights model, and is required by it in order to for it to achieve its goal of enabling right holders to enjoy any decent life. In making this claim I also explore the requirements of the basic right to health care in terms of Shue’s triumvirate of duties and with reference to several key examples. (shrink)

Rather than ‘superbugs’ signifying recalcitrant forms of life that withstand biomedical treatment, drug resistant infections emerge within and are intricate with the exercise of social and medical power. The distinction is important, as it provides a means to understand and critique current methods employed to confront the threat of widespread antimicrobial resistance. A global health regime that seeks to extend social and medical power, through technical and market integration, risks reproducing a form of triumphalism and exceptionalism that resistance (...) itself should have us pause to question. An alternative approach, based on a postcolonial as well as a ‘post-colony’ approach to health and microbes, provides impetus to challenge the assumptions and norms of global health. It highlights the potential contribution that vernacular approaches to human and animal health can play in altering the milieu of resistance. (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)

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)

Rather than making another attempt at proposing a single and unifying theory of global health justice, this timely collection brings together, instead, scholars from a range of traditions to frame the issue more broadly, highlighting not only different perspectives but also key topics and debates. -/- The volume features chapters that offer both new theoretical approaches to global health justice, as well as fresh takes on existing frameworks. Others adopt a bottom-up approach to tackle specific problems, (...) including the sexual rights of children and adolescents, artificial intelligence (AI) in medicine, framing of neglected tropical diseases, securitization of health, and trademarks in global health. Brought together within one volume, the breadth of these chapters provides a unique and enlightening contribution to the wider Global Health field. -/- This important volume will be a fascinating read for students and researchers across Global Health, Bioethics, Political Philosophy, and Global Development. (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)

Some claim that “global health is public health” but most regard global health as a new field, rapidly emerging mostly at North American academic institutions . The term was first incorporated into University of California, San Francisco’s Institute for Global Health in 1999 and UCSF also inaugurated the first North American master of science in global health in 2009. Global health is commonly acknowledged to have historical precedents in tropical (...) medicine and international health. All three fields are regarded as having some overlapping and some distinctive features . One overlapping feature of all three is retaining traces of European and/or North American conquest, imperialism, and colonialism that create a legacy of ongoing ethical challenges for global health . One touted distinctive feature of global health is its .. (shrink)

Widening disparities in health within and between nations reflect a trajectory of ‘progress’ that has ‘run its course’ and needs to be significantly modified if progress is to be sustainable. Values and a value system that have enabled progress are now being distorted to the point where they undermine the future of global health by generating multiple crises that perpetuate injustice. Reliance on philanthropy for rectification, while necessary in the short and medium terms, is insufficient to address (...) the challenge of economic and other systems spinning out of control. Innovative approaches are required and it is suggested that these could best emerge from in-depth multidisciplinary research supported by endeavours to promote a ‘global mind-set.’. (shrink)

As a result of increased interest in global health, more and more medical students and trainees from the.

Global Health involves, among many things the intensified travelling of people, resources, technologies, knowledge, standards, and ideas. This book describes what happens when innovations are transferred to new settings: What work is needed to make them work, but also how they change the setting into which they are introduced.

This article focuses on the access of people in developing countries to medications and medical services that are readily available to inhabitants of industrialized countries. There are, of course, other critical dimensions of public health that require action on a global scale. These include relief for large numbers of people who are starving or living at nearly subsistence levels; provision of a supply of clean, potable water for populations deprived of that essential resource; and the consequences for local (...) agricultural production in countries in which globalization has led to deforestation of vast portions of the land. The focus here on access to health services and needed medications is not intended to minimize the importance of these other areas of global health. (shrink)

Global health law for pandemics currently lacks legal obligations to ensure distributional and reparative justice. In contrast, international environmental law contains several novel international legal mechanisms aimed at addressing the effects of colonialism and global injustices that arise from the disproportionate contributions to — and impacts of — climate change and biodiversity loss.

Should people have a legal human right to health? And, if so, what exactly does protecting this right require? This essay defends some answers to these questions recently articulated in Global Health Impact. It explains how these answers depend on a particular way of thinking about health and the minimally good life, how quality of life matters at and over time, what various agents should do to help people who are unable to live well enough, and (...) many other things. Moreover, it suggests some ways of improving common metrics for measuring and advancing our collective global health impact. (shrink)

How should states and international organizations allocate global health resources? This paper examines proposals for distributing these resources in the literature. First, we look at the literature on the metrics for measuring what matters and consider how they might be modified to avoid some common objections—e.g., that these measures discriminate against the disabled or fail to give due weight to helping the young (or old) or those in present (or future) generations. Second, we canvas existing approaches to evaluating (...) allocations of health‐related resources utilizing such measures and advance a new way of doing so. We suggest that it is important to provide substantive arguments for directly evaluating alternative allocations, but there is also room for deliberation about fair procedures for selecting allocation criteria and securing just outcomes. (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)

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)

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)

Research partnerships between institutions in the Global North and institutions in the Global South have many potential benefits, including sharing of knowledge and resources. However, such partnerships are traditionally exploitative to varying degrees. In order to promote equity in South‐North research partnerships, it is necessary to learn from the experiences of researchers collaborating internationally. This study analyzed transcripts from eleven semi‐structured qualitative interviews with researchers working at Clínica de Familia La Romana, an institution in the Dominican Republic with (...) decades of experience with research and research partnerships with institutions from the Global North. The findings of this study suggest that respect for resources invested in research, as well as for the researchers and institutions themselves, are vital components to a successful global health research partnership. These findings have implications for individual research partnerships, as well as the policies of journals and institutions providing funding that affect these partnerships. (shrink)

This Viewpoint calls attention to the pervasive wrongs related to knowledge production, use, and circulation in global health, many of which are taken for granted. We argue that common practices in academic global health (eg, authorship practices, research partnerships, academic writing, editorial practices, sensemaking practices, and the choice of audience or research framing, questions, and methods) are peppered with epistemic wrongs that lead to or exacerbate epistemic injustice. We describe two forms of epistemic wrongs, credibility deficit (...) and interpretive marginalisation, which stem from structural exclusion of marginalised producers and recipients of knowledge. We then illustrate these forms of epistemic wrongs using examples of common practices in academic global health, and show how these wrongs are linked to the pose (or positionality) and the gaze (or audience) of producers of knowledge. The epistemic injustice framework shown in this Viewpoint can help to surface, detect, communicate, make sense of, avoid, and potentially undo unfair knowledge practices in global health that are inflicted upon people in their capacity as knowers, and as producers and recipients of knowledge, owing to structural prejudices in the processes involved in knowledge production, use, and circulation in global health. (shrink)

The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making (...) health resource allocation decisions. According to our total advantage view: the worst off are those who have the greatest total lifetime disadvantage; advantage foregone due to premature death should be treated in the same way as other ways of being disadvantaged at a time; how badly off someone is depends on the actual outcomes that will befall her without intervention, not her prospects at a time; and all significant forms of disadvantage count for determining who is worst off, not just disadvantage relating to health. We conclude by noting two important implications of the total advantage view: first, that those who die young are among the globally worst off, and second, that the epidemiological shift in the global burden of disease from communicable to non-communicable diseases should not lead to a corresponding shift in global health spending priorities. (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)

Drawing on recent bioethics literature on emerging infectious diseases, as well as the authors’ own previous analyses, this chapter addresses the ethical underpinnings of global health partnerships to combat emerging infectious disease. After an introduction to the topic, section “Introduction” proposes the twin ends of establishing structural justice and ensuring threshold human capabilities as key justice standards. It shows how these standards play a critical role in determining justice in global health partnerships. Section “Next Steps: (...) class='Hi'>Global Health Partnerships” illustrates these justice standards by applying them to the coronavirus 2019 (COVID-19) pandemic. Section “Conclusion” models multi-level global health partnerships that build-in justice considerations and proposes next steps for pandemic preparedness. (shrink)

We have two goals in this paper: first, to provide a diagnosis of global health and underline some of its blockages; second, to offer an alternative interpretation of what the demands for those in global health may be. The assumption that health is a good that requires no further explanation, and that per se it can serve as an actual modus operandi, lays the foundations of the problem. Related blockages ensue and are described using HIV (...) prevention with a focus on vaginal microbicides as a case study. Taking health as a self-evident, and self-explanatory “good” limits other possible goods; and prevents inquiry into the actual practices of creating good. We propose that to create conditions under which global health could be reconstructed, problematization be taken up as a practice, around a series of questions asked in conjunction with those ever-urgent ones of how to ameliorate the condition of living beings. (shrink)

The connection between health and human rights continues to play a prominent role within global health law. In particular, a number of theorists rely on the claim that there is a relation of interdependence between health and human rights. The nature and extent of this relation, however, is rarely defined, developed or defended in a conceptually robust way. This paper seeks to explore the source, scope and strength of this putative relation and what role it might (...) play in developing a global health law framework. (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)

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)

ObjectiveThe literature has shown the relevance of certain psychological variables in adjustment to cancer. However, there is a great variability, and these features could be modified through the disease process. The aim of this study is to provide an integrated and global perspective of the importance of variables such as coping, resilience, emotional control, social support, affect, and others in cancer patients through a longitudinal study, with the objective of exploring their associations and underlying interactions.MethodsThe sample was composed of (...) 71 people diagnosed with cancer who were attending psychological support at the Spanish Association Against Cancer. We assessed the following variables in two periods of 6 months: perceived stress, emotional control, resilience, coping strategies, personality, social support, affect, emotional distress, quality of life and visual-analogic scales.ResultsResults showed predictive effects of perceived stress on physical health perception. Mental health perception was influenced by almost all the psychological variables. Consciousness at baseline, change in Extraversion and Resilience had significant effects on perceived mental health.ConclusionThis study provides a global health model that integrates and explores associations between psychological variables related to cancer disease. This information could be useful for guiding personalized psychotherapeutic interventions, with the aim of increasing adjustment to disease. (shrink)

One of the most ambitious and sophisticated recent approaches to provide a theory of global health justice is Sridhar Venkatapuram's recent work. In this commentary, we first outline the core idea of Venkatapuram's approach to global health justice. We then argue that one of the most important elements of the account, Venkatapuram's basis of global health duties, is either too weak or assumed implicitly without a robust justification. The more explicit grounding of the duty (...) to protect and promote health capabilities is based on Martha Nussbaum's version of the capability approach. We argue that this foundation gives rise to humanitarian duties rather than duties of justice proper. Venkatapuram's second argument from the social determinants of health thesis is instead a stronger candidate for grounding duties of justice. However, as a justificatory argument, it is only alluded to and has not yet been spelled out sufficiently. We offer plausible justificatory steps to fill this gap and draw some implications for global health action. We believe this both strengthens Venkatapuram's approach and serves to broaden the basis for future action in the area of global health. (shrink)