Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-05T04:08:46.268Z Has data issue: false hasContentIssue false
  • English
  • Français

International Justice and Health: A Proposal

Published online by Cambridge University Press:  28 September 2012

Gopal Sreenivasan
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper discusses obligations of international distributive justice-specifically, obligations rich countries have to transfer resources to poor countries. It argues that the major seven OECD countries each have an obligation to transfer at least one percent of their GDP to developing countries.

The strategy of the paper is to defend this position without having to resolve the many debates that attend questions of international distributive justice. In this respect, it belongs to the neglected category of nonideal theory. The key to the strategy is to show that a significant amount of good would be accomplished by a one percent transfer, despite the fact that one percent is quite a small amount.

To make this showing, the paper takes health as a fundamental measure of individual well-being and examines the improvement in life expectancy that would likely result from devoting the one percent transfer to the major determinants of health. It adduces data indicating that substantial progress towards raising life expectancy in developing countries to the global average of 64.5 years can be expected from expenditures of $125 per capita, divided between health care, education, and basic nutrition and income support. A one percent transfer from the major seven is enough to cover expenditures on that scale for the poorest fifth of the world's population.

Type
Articles
Information
Ethics & International Affairs , Volume 16 , Issue 2 , September 2002 , pp. 81 - 90
Copyright
Copyright © Carnegie Council for Ethics in International Affairs 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Marmot, MichaelInequalities in Health New England Journal of Medicine 2001 345 no. 2p.134CrossRefGoogle ScholarPubMed, citing Murray, C J L et al. U.S. Patterns of Mortality by County and Race: 1965–1994 1998 CambridgeHarvard Center for Population and Development StudiesGoogle Scholar).

2 Rawls, JohnA Theory of Justice 1999 rev. ed.CambridgeHarvard University Press[1971]), p.63Google Scholar.

3 World Health Organization World Health Report 2001 2001 GenevaWHO Publications), Annex Table 1, pp.136–43Google Scholar; available at http://www.who.int/whr/2001/main/en/pdf/annex.en.pdf.

4 Mathers, Colin et al. Healthy Life Expectancy in 191 Countries, 1999 Lancet 2001 357 no. 9269p.1687CrossRefGoogle ScholarPubMed.

5 WHO World Health Report 2000 2000 GenevaWHO PublicationsAnnex Table 2, pp.156–63Google Scholar; available at http://www.who.int/whr/2001/archives/2000/en/pdf/Annex2-en.pdf. Subsequent references to 1999 life expectancy figures are all drawn from this table.

6 Rawls, A Theory of Justice 78Google Scholar.

7 See, especially, Beitz, CharlesPolitical Theory and International Relations 1999 rev. ed.PrincetonPrinceton University PressGoogle Scholar [1979]), part III; and Pogge, Thomas WRealizing Rawls 1989 IthacaCornell University PressGoogle Scholar), part III.

8 Beitz, Political Theory and International Relations 143–61Google Scholar.

9 Rawls, JohnThe Law of Peoples 1999 CambridgeHarvard University PressGoogle Scholar).

10 Rawls, The Law of Peoples 8990Google Scholar. Beitz, ComparePolitical Theory and International Relations 170–71Google Scholar.

11 Compare Pogge, Thomas W Eradicating Systematic Poverty: Brief for a Global Resources Dividend Journal of Human Development 2001 2 5977CrossRefGoogle Scholar.

12 Beitz, Political Theory and International Relations 152–53Google Scholar; and Murphy, LiamNagel, Thomas Taxes, Redistribution, and Public Provision Philosophy & Public Affairs 2001 30 no. 16970CrossRefGoogle Scholar.

13 Organisation for Economic Co-operation and Development Main Economic Indicators, August 2002 2002 ParisOECDp.279Google Scholar; available at http://www.oecd.org/pdf/M00018000/M00018516.pdf. The figure reported is in 1995 dollars.

14 United Nations Development Programme Human Development Report 2001 2001 New YorkOxford University Pressp.190Google Scholar; available at http://www.undp.org/hdr2001/back.pdf.

15 See Daniels, NormanKennedy, BruceKawachi, IchiroIs Inequality Bad for Our Health 2000 BostonBeacon PressGoogle Scholar); Marmot, MichaelWilkinson, RichardSocial Determinants of Health 1999 New YorkOxford University PressGoogle Scholar); and Leon, DavidWalt, GillPoverty, Inequality, and Health: An International Perspective 2001 New YorkOxford University PressGoogle Scholar).

16 Leon, DavidWalt, GillGilson, Lucy International Perspectives on Health Inequalities and Policy British Medical JournalMarch 10, 2001 322p.592CrossRefGoogle Scholar. Figure reproduced with permission from the BMJ Publishing Group.

17 Ibid.Google Scholar

18 Ibid.Google Scholar

19 The other country is AfghanistanGoogle Scholar.

20 Sub-Saharan Africa had a population of 591 million in 1999. UNDP Human Development Report 2001 p.157Google Scholar. My calculation assumes that per capita health expenditure in these countries was zero, which understates it (and so, the impact of the transfer) a little.

21 For present purposes, the appropriate multiplier should really reflect the prices of health-sector goods specifically, such as medicine and health-care labor. However, according to a recent survey, “health-specific price indices are unavailable.”Musgrove, PhilipZeramdini, RiadhCarrin, Guy Basic Patterns in National Health Expenditure Bulletin of the World Health OrganizationSeptember 2002 80 no. 2p.136Google Scholar. The World Bank's widely employed PPP rates, which I use in the text, reflect general consumption prices rather than health-specific ones. They must therefore be regarded as a rough approximation. For disaggregated health-sector data, and criticism of the World Bank's calculations, see Sanjay Reddy and Thomas W Pogge, “How Not to Count the Poor,” especially Table XB; available at http://www.socialanalysis.org.

22 UNDP, Human Development Report 2001 p.181Google Scholar. The average multiplier for the least developed countries is 4.09 and for sub-Saharan Africa 3.18.

23 See, e.g., Caldwell, John Routes to Low Mortality in Poor Countries Population and Development Review 1986 12 no. 2171220CrossRefGoogle Scholar; Hobcraft, John Women's Education, Child Welfare and Child Survival: A Review of the Evidence Health Transition Review 1993 3 no. 2159–75Google Scholar; and Anand, SudhirRavallion, Martin Human Development in Poor Countries: On the Role of Private Incomes and Public Services Journal of Economic Perspectives 1993 7 no. 1133–50CrossRefGoogle Scholar. Even division is a starting-point and illustration. In principle, allocations to the various determinants should reflect their respective contributions to health.

24 Mehrotra, SantoshJolly, RichardDevelopment with a Human Face: Experiences in Social Achievement and Economic Growth 1997 OxfordClarendon PressGoogle Scholar).

25 See, e.g., Sen, AmartyaDevelopment as Freedom 1999 New YorkKnopfGoogle Scholar), ch. 2.

26 Musgrove, et al. Basic Patterns in National Health Expenditure p.145Google Scholar.

27 UNDP, Human Development Report 2001 171211Google Scholar. The PPP multiplier for Sri Lanka is 3.89 (p. 179).

28 Sen, Amartya The Economics of Life and Death Scientific American May 1993p.45Google Scholar.

29 Sen, Development as Freedom 99103Google Scholar. Of the poorest 20 percent of the global population in 1990, about half lived in India, while about a quarter lived in sub-Saharan Africa. Gwatkin, DavidsonGuillot, MichelHeuveline, Patrick The Burden of Disease among the Global Poor Lancet 1999 354 no. 9178p.587CrossRefGoogle Scholar.

30 World Health Organization Macroeconomics and Health: Investing in Health for Economic Development 2001 GenevaWHO PublicationsGoogle Scholar); available at http://www.cid.harvard.edu/cidcmh/CMHReport.pdf. For a brief summary, see Jha, Prabhat et al. Improving the Health of the Global Poor ScienceSeptember 2002 295 2036–39CrossRefGoogle Scholar.

31 WHO Macroeconomics and Health Appendix 2, p.164Google Scholar. For all countries, the average per capita cost is $38 in 2007 and $42 in 2015.

32 Ibid., pp.181634Google Scholar.

33 Ibid., p.71Google Scholar.

34 Some may deny that there are obligations to transfer resources among nations at all (save, perhaps, for contractual ones). Their position sits very poorly with the strong intuitive reaction to the international differences in life expectancy with which we began, namely, that morally something is definitely amiss.

35 Rawls, The Law of 'Peoples 115–19Google Scholar.

36 Rawls recognizes a “duty to assist burdened societies,” the aim of which is to help them to become well-ordered. As part of this ultimate aim, the duty also tries to secure, up to a point, the “basic needs” of individuals in burdened societies. Ibid., pp. 106, 114–16. In this qualified sense, the transitional resource transfers that Rawls requires share our aim of securing the well-being of individuals.

37 In fact, the cutoff point has to be more complicated than this, since it should accommodate the difficulties with the use of national averages noted previously. A first approximation would be to count Indian states and Chinese provinces as separate units of assessment. This is the approach taken by Gwatkin et al., “The Burden of Disease among the Global Poor,” p. 587.