Global health: the biggest bioethics challenge of all?

Tackling global health inequalities poses a huge challenge and raises many ethical issues.  The Nuffield Council on Bioethics held an international symposium to draw out some of the most pressing problems and guide its future work in this field. Catherine Joynson summarises. 

Global inequality in health has long been on the Nuffield Council on Bioethics’ list of future work topics. But, the sheer size and breadth of the problem has meant that making a meaningful contribution in this area has, up to now, felt very much out of reach.

We needed outside guidance. So, as part of the Council’s 20^th anniversary activities, I was tasked with bringing together people from all over the world to gain a global perspective on what the main challenges in global health are, and what an organisation such as ours could add.

Nine months later, on 22 June 2011, the symposium Global health: responsibility, ethics and policy was held in London. Council members and staff were proud to welcome 130 delegates to share in the knowledge and experiences of 20 distinguished speakers who travelled from Australia, China, India, Jamaica, Mexico, Morocco, Tanzania and the US to be with us.

A core theme of the meeting was the question of who has responsibility to ameliorate disparities in global health. The principle of reciprocity, and the fact that no country can insulate itself from major health hazards, argues that global health is in the interests of all states, particularly richer countries who have greater capacity to assist. In the UK, the Health Protection Agency recognises that ‘health is global’ and has research and monitoring centres, mainly dealing with communicable disease, all over the world.

However, we heard that many global health programmes were highly unsuitable for developing countries, focussing on the introduction of new technologies or disease-specific programmes, rather than on strengthening local efforts to secure effective, high-quality, inclusive health systems. In a stark example, an international NGO piloted a vaccine programme in India, which to roll out nationwide would cost four times the public healthcare budget for the whole country. Eighty percent of health services in India are currently provided by commercial companies, making the cost of healthcare a major cause of poverty, and putting into perspective current grumblings about the UK’s National Health Service.

The breakout session I attended served to remind us that non-health policies bear just as heavily upon health, for example those relating to education, housing, employment and defence.  As one speaker said, what good does it do to treat people’s illnesses and then give them no choice but to return to the conditions that made them sick? The People’s Health Movement is a pioneer in this area, supporting activists who are fighting for health as a human right in 75 countries across the globe. Their charter states: “Inequality, poverty, exploitation, violence and injustice are at the root of ill health and the deaths of poor and marginalised people.”

The Nuffield Council’s members and speakers, who met again the day after the symposium, left full of ideas for topics that the Council might examine and report on – including health worker migration and the influence of non-state actors such as charities, journals and the commercial sector.

It is clear, however, that the Council cannot ‘do’ global health in a single inquiry, and that very many bioethical issues have an international component. Whether the Council should establish a longer term programme of work in this area will be considered by members in the autumn. Whatever direction we decide upon, we hope that the new friends we have made around the world will help us to take a more global view in all aspects of our work in future.

You can watch an 8 minute highlights video above. Slides from the presentations made are available on the Council’s website and a detailed report will be available soon. You can also sign up for email updates on the Council’s international work.

Catherine Joynson

Catherine Joynson is Communications Manager at the Nuffield Council on Bioethics.

The Nuffield Council on Bioethics is an independent body funded jointly by the Nuffield Foundation, the Wellcome Trust and the Medical Research Council. The Council celebrates its 20th anniversary this year.