What can be done about the poor state of global health?
February 17, 2011 1 Comment
Blog Post By Solomon Benatar, University of Cape Town & Gillian Brock Department of Philosophy, University of Auckland
What can be done about the poor state of global health? How are global health challenges linked to the global political economy and to issues of social justice? What are our responsibilities and how can we improve global health? These questions are addressed from the perspective of medicine, philosophy and the social sciences. Offering a wealth of empirical data and both practical and theoretical guidance, this is a key resource for bioethicists, public health practitioners, and philosophers.The raison d`etre for this book is to draw attention to what we consider to be one of the largest and most important challenges facing humanity in the 21st century – to improve and promote global health. By global health we mean the health of all people globally within sustainable and healthy living (local and global) conditions. In order to achieve this ambitious goal we need to understand, among other things, the value systems, modes of reasoning, and power structures that have driven and shaped the world over the past century. We also need to appreciate the unsustainability of many of our current consumption patterns before we can address threats to the health and lives of current and future generations.
The world and how we live in it have been changing dramatically over many centuries, but in the past fifty years change has been more rapid and profound than ever in the past. Many positive changes have been associated with impressive economic growth, advances in science and medicine and in social policies regarding access to health promotion. These include more equitable access to primary care, greater focus on a primary health care approach, expansion of social programmes to improve living conditions and a welcome increasing emphasis on the rights of all individuals to be equally respected.
Sadly, emphasis on the exaggerated expectations of the most privileged people has resulted in neglect of a large proportion of the world’s population with consequent widening disparities in wealth and health. In addition many of the world’s health-care ‘systems’ have become: distorted, dysfunctional, and unsustainable. By distorted we mean that health care services are not designed to meet the range of demands posed by local burdens of disease equitably. They are dysfunctional because they are driven more by adverse market forces and the requirements of bureaucracy, than by emphasis on serving patients optimally and sustaining the professionalism required of health care workers in the care of patients and the training of new generations of professionals. Finally, marginal benefits for a few are often prioritized while other cost-effective activities of potentially great benefit to many more people are ignored. Within limited resource environments, such strategies that contribute to costs of health care rising disproportionately are likely to prove unsustainable.
Disparities in health and in access to health care thus continue to widen globally. Such disparities, combined with population growth, unsustainable consumption patterns, the emergence of many new infectious diseases (and multi-drug resistance), escalating ecological degradation, numerous local and regional wars, a stockpile of nuclear weapons, massive dislocations of people and new terrorist threats (to list just a few relevant factors) have severe implications for individuals’ and populations’ health. Deeper understanding of the challenges we face and of the feasible changes that could be made to address these, are necessary first steps towards expressing better commitment to genuine respect for the dignity of all people (and, indeed, showing respect for everyone’s dignity is an ideal our international agreements increasingly claim to embrace).
Adequate understanding of ethical issues concerning health requires that we extend our focus from the micro-level of individual health and the ethics of interpersonal relationships to include ethical considerations regarding public and population health, and justice concerns more generally. The domain of global health ethics provides a context within which the many relevant disciplines that have valuable insights to offer can usefully engage, and through that engagement promote better understanding of the extensive changes that are needed. Furthermore, developing a global state of mind about the world, and our place in it is, is arguably relevant to making many of the necessary, progressive changes.
After noting the poor state of global health, there are three main issues covered by almost all contributing authors. They direct our attention to ways in which we exacerbate poor global health, what we should do to remedy the factors identified, and offer reasons why we ought to do something about the highlighted problems, thereby connecting global health issues more strongly with the domain of justice. Many of the chapters in this volume provide constructive suggestions about how national and global policy and institutional changes could function differently to make significant improvements. Together they contribute to a deeper understanding of the challenges we face in trying to improve global health and provide much practical and theoretical guidance, which builds a case for our ability to make a real difference if we so choose.
To improve people’s health globally and pursue the goals described in this book will require a considerable amount of collaborative multidisciplinary research and pervasive community engagement at many levels. It is arguable that this challenge is as great as, if not greater than developing an HIV vaccine. If equivalent research resources and intellectual attention were to be allocated to such research, significant progress is entirely possible. While we have considerable intellectual and material resources to improve global health, there is little reason to expect that major new initiatives, such as those envisaged in this text will be implemented without a great deal of effort in mobilizing the political will to do so. However, like Jonathan Glover and others, we retain an element of hope that well constructed arguments can, on occasion and in the right circumstances, play a significant role in influencing the future. To end on a more optimistic and inspiring note, as Nelson Mandela famously said: “It always seems impossible until it’s done.”
Solomon Benatar & Gillian Brock are editors of Global Health and Global Health Ethics, published by Cambridge University Press