The state of global health is a major concern. Despite advances in medicine and medical care and massive growth of the global economy, health in the world is characterized by widening disparities within and between countries; lack of access to even basic health care for billions of people; the emergence of multidrug-resistant tuberculosis, HIV, and many other new infectious diseases; rising costs of commercialized health care; and massive increases in the incidence of obesity and diabetes.
The causes are multifactorial and complex: overlapping crises in the economy; food and water security; education; demographic changes resulting from wars, refugees, and ageing; the environment; and global leadership. But the ideology behind the deliberately structured global political economy is a central factor when it is used to justify corrupt and even fraudulent activity.
Understanding what has led to widening disparities in health and the implications for the remainder of the 21st century, if we continue along the same trajectory, should prompt deep introspection and examination of our values. Many influential people, along with ordinary citizens, claim to value freedom, human rights, progress based on reason, human dignity, democracy, competitiveness in free markets, and economic growth through consumption. But these values have been used to justify strategies and power relations that benefit a small proportion of the world’s population, with inadequate regard for their impact on the majority who continue to live in poverty and poor health with little prospect for improvement. A prime example is financial institutions taking advantage of “freedom” to make unwise investments, which led to the global financial crisis in which many people lost their homes and pensions and many more were thrown into poverty.
Reflective inquiry and greater understanding of the complexity of our value system and its distortions can provide some insights into the pathophysiology of the above crises. Such inquiry also emphasizes our responsibility to future generations and to other forms of life with which we share our increasingly threatened planet.
The prognosis of an ongoing trajectory of “progress” conceived of along conventional lines needs to be seriously contemplated to better understand what treatments could and should be implemented to alter the balance of forces affecting global health. It is in this context that questions arise about what global health ethics implies and whether it is needed as a distinct paradigm from bioethics or public health ethics. This question and the many other issues mentioned above are explored from medical, philosophical, and social-science perspectives by 44 authors from eight countries and four continents in Global Health and Global Health Ethics.
Since the book was published in 2011 there has been an increasing number of publications on international and global health challenges, as well as a proliferation of courses on this topic, reflecting expanding academic interest in population health. Regrettably, few new insights have been translated into imaginative, innovative societal actions that could address the underlying social structures and belief systems that lie at the heart of the crises. We need to marshal ingenuity and resources to promote the collaborative transdisciplinary research that could lead to as yet untried actions to respond to the power relations that sustain local and global inequalities.
The task of developing an HIV vaccine illustrates the need for a transdisciplinary approach to finding solutions to a highly complex medical problem. By analogy I suggest that bioethicists should contribute to teamwork addressing complex macro-societal problems and facilitate a paradigm shift in approach to global health (and other global challenges such as climate change) as suggested many years ago by Van Rensselaer Potter. It would be myopic not to do so.
Solomon R. Benatar, a Hastings Center Fellow, is an emeritus professor of medicine at the University of Cape Town, a visiting scholar at the Joint Centre for Bioethics at the University of Toronto, and co-editor of Global Health and Global Ethics. He is also a recipient of the Henry Knowles Beecher Award.