Reflections on the political economy of planetary health

Abstract

This article seeks to contribute to debates on the political economy of global health by offering a ‘planetary’ perspective. We initially sketch contestations concerning improvements, inequalities and inequities in the state of global health in order to move towards a more integrated conception of significant social forces driving transformations in health, society and ecology. We then explore key agencies (e.g. large energy and pharmaceutical corporations; sympathetic governments) and structures of contemporary capitalism to interrogate their impacts on health care and ecology, for example in driving global pollution and climate change. We propose that such forces play a significant role in an unprecedented planetary organic crisis. Finally, we suggest that the world has reached an historical crossroads, necessitating a significant change of direction to promote a more ethically and ecologically sustainable, socially just future and argue for new paradigms of health that are ‘planetary’ in scope and perspective.

Keywords:

• Inequality
• ecology
• power of capital
• market civilization
• anthropocene
• capitalocene
• structure
• agency
• planetary health
• ethics

Notes

Acknowledgements

We are grateful for invaluable comments and suggestions by Isabella Bakker, Matthew Dow, Dillon Wamsley and Owain Williams, and to four anonymous reviewers.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes on contributors

Stephen Gill is Distinguished Research Professor of Political Science, Communications and Culture, York University, Canada; Fellow, Royal Society of Canada and Senior Associate Member, St. Anthony's College, Oxford. He was elected Vice-President of the 7500-member International Studies Association (ISA) in 2003; as the ISA's youngest-ever Distinguished Senior Scholar in International Political Economy (2006); and named as one of the top 50 all-time thinkers in International Relations in M. Griffiths et al, Fifty Key Thinkers in International Relations (2009). Gill has received many fellowships (including two Fulbright awards) and Visiting Chairs, including at: The University of Tokyo; UCLA; New York University; University of California Santa Barbara; University of Helsinki; and, most recently, the Hallsworth Chair in Global Studies at The University of Manchester. His interests include global political economy, international relations, law, constitutionalism, governance and social and political theory. He has published 21 peer-reviewed volumes and over 150 peer-reviewed articles and essays. (For more details see http://www.stephengill.com/).

Solomon R. Benatar is Emeritus Professor of Medicine at the University of Cape Town. He was Professor of Medicine and Chief Physician at Groote Schuur Hospital from 1980 to 2007 and Chairman of the Department of Internal Medicine from 1980 to 1999. Previous positions inter alia, included: Founding Director of the UCT Bioethics Centre (1992–2012); Senior Vice President of the College of Medicine of South Africa; President of the International Association of Bioethics (2001–2003); Visiting Professor of Social Medicine at Harvard Medical School and Fellow in the Program in Ethics and the Professions at Harvard University (1994–1995); and Director of a US NIH (Fogarty International Center) funded program for capacity building in International Research Ethics in southern Africa (2003–2010). He has been an annually invited teacher, mentor and scholar at the University of Toronto since 2000. His interests include respiratory medicine, health services, human rights, medical ethics and global health on which topics he has published over 280 peer-reviewed journal articles and 60 book chapters. (For more details see http://www.dlsph.utoronto.ca/faculty-profile/benatar-solomon-solly-robert/).

Notes

1 A baby born in Pakistan is almost 50 times more likely to die within the first month of life than a baby born in Japan. But a country’s income explains only part of the story. The risk of dying as a newborn in the high-income US and Kuwait (respectively 4.4 and 3.7 deaths for every 1000 live births) is only slightly lower than the risk for babies in low-income countries such as Sri Lanka and Ukraine (5.3 and 5.4, respectively). See (UNICEF, 2018).

2 This is the section of the world population at which ‘poverty eradication’ is hypocritically aimed by many policymakers and bureaucrats, with little real understanding of what it means to live at this level.

3 In the USA, where the health care system is privatized, a majority of the population are in favor of socialized provisions.

4 Cited in Jean M. Twenge. January 12 2018. “Tech bosses limit their kids’ time on smartphones: why shouldn’t we?” The Guardian.

5 Olivia Solon. 9^th November 2017. Ex-Facebook president Sean Parker: site made to exploit human ‘vulnerability’. The Guardian.

6 Hannah Kuchler. 30 January 2018. ‘Health advocates: Facebook to scrap Messenger Kids App.’ Financial Times.

7 Economic considerations cannot be avoided, given the extraordinarily high expectations of patients and physicians for care, even when treatments seem futile. Accountable, transparent priority setting is required to ensure sustainability. See Daniels and Sabin (1997).

8 As of 24th September 2018, the US government estimate of world population was: 7.51 billion. Estimates based on the US Census Bureau: https://www.census.gov/popclock/world.

9 Gross world product (the combined gross national product of all countries) was US $79.45 trillion in nominal dollars (2017 est.) and US $127 trillion in terms of purchasing power parity. Estimates taken from CIA World Factbook 2017. Available online at: https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html. One estimate for 1950 gross world product was roughly US $4.082 trillion, measured in 1990 dollars (Delong, 1998).