Just Global Health

This chapter offers an integrated account of two strands of global health justice: health-related human rights and health-related common goods. After sketching a general understanding of the nature of human rights, it proceeds to explain both how individual human rights are to be individuated and the content of their associated obligations specified. With respect to both issues, the human right to health is taken as the primary illustration. It is argued that (1) the individuation of the right to health is fixed by reference to the subject matter of its corresponding obligations, and not by the interests it serves, and (2) the specification of the content of that right must be properly responsive to thresholds of possibility and burden. The chapter concludes by insisting that human rights cannot constitute the whole of global health justice and that, in addition, other considerations—including the promotion of health-related global public goods—should also shape such policy. Moreover, the relationship between human rights and common goods should not be conceived as mutually exclusive. On the contrary, there sometimes exists an individual right to some aspect of a common good, including a right to benefit from health-related common goods such as programs for securing herd immunity from diphtheria.

One Health: How Interdependence Enriches Veterinary Ethics Education

What does One Health imply for veterinary ethics education? In order to answer this question, we will first have to establish what One Health itself involves. The meaning and scope of One Health, however, cannot be established without reference to its values—whose health matters? Veterinary ethics education is well equipped to facilitate such an open-ended inquiry into multispecies health. One Health also widens the scope of veterinary ethics by making salient, among other fields, environmental ethics, global health justice, and non-Western approaches to ethics. Finally, One Health requires students to engage with interdependence. Discussing three levels of interdependence, we argue that veterinary ethics stands to benefit from a more contemplative pedagogy.

Global Health Governance as Shared Health Governance

PG as a global health justice theory joins with the theory of SHG to apply justice principles to health governance. SHG rests on a genuine commitment among global health actors to achieve health justice as opposed to pursuing narrow self, group, or state interests alone. SHG elucidates standards of global and domestic responsibility and accountability for health equity. It proposes a common conceptual and policy framework with a set of distinct but complementary responsibilities for governments, nongovernmental organizations (NGOs), the private sector, and individuals themselves. In the SHG framework, the state has duties to create conditions in which all individuals have the opportunity to be healthy and to reduce and prevent the shortfall between actual and potential health within their countries. Global actors have a duty to help shape conditions in which countries can develop and flourish and promote the health of their populations.

Global Health Justice and Governance

Critical and dangerous threats imperil global health. Serious health disparities, hazardous contagions that can circle our globalized planet in hours, a bewildering confusion of health actors and systems all combine in a kaleidoscopically fragmented, incoherent, and unjust global health enterprise. While a growing body of work in global justice and international relations explores moral issues and global governance, very little of it has linked principles of global health justice to governance to create a theory of global health. But the dangers confronting the world make a theoretical framework essential, to enable analysis of the current system and to ground proposals to reform it and align it with moral values. This book presents a global justice theory—provincial globalism (PG)—and links it with the theory of shared health governance (SHG) to offer an alternative to the prevailing modus operandi, which has manifestly failed to serve global health. The PG/SHG framework advances health capability, and specifically the capability to avoid premature death and preventable morbidity, as the proper goal of health systems and policy. This framework sees human flourishing as global society’s end goal and proposes an ethical demand for health equity as the criterion for evaluating global health policy and law. It examines the current actors in global health, assessing their strengths and weaknesses, and proposes assigning responsibilities to actors at all levels according to their functions and capabilities.

Fulfilling Global Health Justice Requirements

Ensuring that medically necessary and appropriate health care and public health goods and services are available to all is the job of justice. The PG/SHG framework aspires to a goal of self-actualized societies imbued with a commitment to social justice, where governments and people promote the central health capabilities of all. Individual states have primary obligations to prevent and address health inequalities and externalities and to realize their populations’ health capabilities. The global community provides help and guidance when states fail to deliver, though this framework eschews coercive tactics. Rather, PG/SHG deploys public dialogue and education programs to swell support for these commitments. PG/SHG offers a conceptual model of health capability and guidance for operationalization.

Contrasting Theories of Global Justice

Theories of global justice fall into four main perspectives: realism, particularism, social contractarianism (society of states), and cosmopolitanism. But health justice remains largely unheeded in these justice theories. More recently, some theorists have turned to health; the perspective most frequently used to ground health obligations is the human rights view. Yet all these frameworks fall short of providing the necessary normative foundation for global health justice. Nor does global bioethics as a discipline address global health justice adequately. Health-sphere actors—global, state, and non-state—need to understand their interests more comprehensively. A more fully developed moral framework and ethical guidelines are essential if health-sphere actors are to tackle global health problems effectively.