Skip to main content

Table 1 Importance of the health of the global poor 1 on four accounts of justice

From: Global health and national borders: the ethics of foreign aid in a time of financial crisis

  Singer Pogge Shue Rawls
Addressed to whom? Indvidual moral agents Individuals & national governments Individuals & national governments National governments & their peoples
National borders important? No Possibly Yes Yes
Key concepts Individuals have an obligation to prevent the occurrence of something significantly bad if they can do so at acceptable cost to themselves. We have a duty not to cause severe harm for minor gain. This obligation remains equally valid if an agent is responsible for causing harm in a jurisdiction outside his or her national borders, and is independent of whether we should privilege obligations to compatriots. Two basic rights – subsistence and security–constitute pre-conditions for the enjoyment and exercise of all other rights and freedoms. Liberal democratic states have a duty to adopt foreign policies consistent with these fundamental human rights. Under an idealised form of social contract, representatives of free and equal societies would adopt 8 principles of governance that enable an ideal global community to live together over time in peace, harmony and mutual respect.
Is health of the global poor important? Yes Yes, under certain conditions Yes, to a limited extent Yes, if useful to achieve just political arrangements
Why? The global rich can ameliorate the suffering of the global poor with little sacrifice to themselves. The international community is in some instances causally implicated in the genesis and perpetuation of severe poverty and ill health worldwide. In instances where national governments fail to protect basic rights, others have a duty to guarantee their fulfilment. The right to subsistence guarantees every person worldwide a decent chance at a long and healthy life. The 8 principles include a duty to “assist other peoples living under unfavourable conditions that prevent their having a just or decent political and social regime.” Empirical evidence shows that population health contributes to just political arrangements.
What kind of obligation? 2 Justice Justice Justice Justice or charity3
What is the extent of the obligation? Until suffering has been eliminated Until causal responsibility for harm has been corrected and adequately compensated4 Until a basic minimum has been provided Until the international community has enabled burdened societies to develop just political arrangements
Which health-related strategies should be privileged? Poverty alleviation & action on other determinants of health Examination of national policy coherence to avoid causing or contributing to harms abroad; Examination of national policy coherence to avoid depriving or contributing to deprivation abroad; Those that strengthen basic institutions to a minimally decent threshold, enabling further social development. Candidate strategies could (1) promote equality of opportunity (especially in education and training), e.g. through child health; (2) offer additional synergies for development, e.g. by focussing on the rights and fundamental interests of women.
  Provision of health care Analysis of the effects of global institutions Provision of aid to ensure subsistence rights6, including guarantees related to the social determinants of health and minimal preventive health care.  
   Institutional reforms to promote satisfaction of human rights5   
  1. 1 The World Bank defines poverty as “pronounced deprivation in well-being” comprising multiple dimensions such as low incomes and the inability to acquire the basic goods and services necessary for survival with dignity, low levels of health and education, poor access to clean water and sanitation, inadequate physical security, lack of voice, and insufficient capacity and opportunity to better one’s life. The global poor are poor in an absolute sense [20].
  2. 2 Each theory takes a position on the question of whether duties towards the health of those outside our borders are matters of “justice” or “charity”. Duties of justice are precise, owed to specifiable others, and can in principle be legally enforced, whereas duties of charity admit of discretion in relation to their nature, timing, and choice of beneficiary. Charitable duties are adopted through conscious choice and are not legally enforceable.
  3. 3 For Rawls, the duty to assist is a duty of justice under the principles of the Law of Peoples. Beyond the threshold of minimal decency, the duty to assist becomes charity.
  4. 4 According to Pogge, degree of responsibility is proportional to benefits reaped and is discharged when proportional compensation is made [21].
  5. 5 For Pogge, a guarantee of human rights aims to confer on all human beings worldwide “secure access” to “minimally adequate shares” of basic freedoms of participation, of food, drink, clothing, shelter, education and health care [22].
  6. 6 For Shue, minimal economic security, or subsistence, entails “unpolluted air, unpolluted water, adequate food, adequate clothing, adequate shelter, and minimal preventive public health care [23].