Values in global health governance

Abstract

In the 60 years since the Universal Declaration of Human Rights was promulgated, the promise of achieving respect for the human rights, health and well being of all is becoming an ever more distant prospect. We have not even remotely met the challenge of improving health for a large proportion of the world's population, and the prospects for improving global health seem to be receding in the current deteriorating economic and political climate. As global health remains one of the most pressing problems of our time, we must question the values that direct our actions and current approaches, which proclaim ‘human rights to health’ but which subsume these rights to a broader paradigm of unregulated global market economics and national politics, rather than working to make these oft-contradictory goals mutually compatible through justifiable and accountable global governance processes. We suggest that a new balance of values and new ways of thinking and acting are needed. These must transcend national and institutional boundaries and recognise that health in the most privileged nations is closely linked to health and disease in impoverished countries. Sustainable development of health and well-being is a necessity for all, and values for health should permeate every area of social and economic activity.

Keywords:

• values
• human rights
• global economy
• liberalism
• managerialism
• disparities
• global health
• governance

Notes

1. Corporations have many rights equivalent to those of persons – for example, freedom of movement and their ability to freely move money around the world. Some trade rules and intellectual property rights protection allow them much greater power than individuals, so they enjoy privileged rights. The right to make profits can also override the rights of individuals to social services such as education and access to therapeutic drugs and health care. The IMF, in attaching strict austerity measures to its assistance programmes to countries experiencing balance of payments crises, privileges the rights of creditors and the creditworthiness of borrowers over other social goals. Monetary contraction and interest rate increases, for example, can exacerbate recessions in the name of economic stabilisation.

2. As Pogge explains, ‘when formulating the first Millennium Development Goal (MDG-1) in 2000 the world's governments subtly changed the language of the [1996 World Food Summit] pledge, now promising to halve not the number, but the proportion of those in extreme poverty. This modification dilutes the number of poor to a population whose growth, all by itself, lowers the proportion. In interpreting this diluted target, the UN shrewdly related the number of extremely poor not to the growing world population, but to a faster-growing population of the less developed countries. The UN also backdated the baseline to 1990, thereby capturing additional population growth as well as a 170 million reduction in extreme poverty that China had reportedly achieved in the decade before adoption of the MDG-1. The result of these clever revisions is dramatic. The World Food Summit promise was to reduce by half the number of extremely poor: from 1,087.8 million in 1996 to 543.9 million in 2015. MDG-1 promises a 17% reduction: from 1,087.8 million in 2000 to 905.2 million in 2015. Its subtle reinterpretations – ignored by the media – have slashed by 361.3 million the 543.9 million promised earlier and have thereby added these 361.3 million to the number of those in extreme poverty in 2015 is deemed morally acceptable’.