Global health and bioethics


The May 16th issue of JAMA provided a large helping of food for ethical thought. The theme was Global Health, and, perhaps unsurprisingly, the terms “moral imperative” and “ethical imperative” flew thick and fast in the many thoughtful editorials and viewpoint articles. Consider the following, culled from the issue’s pages:

There is a wide variation in per capita health expenditures around the globe, from $7000 in the US to less than $10 in Eritrea.

To provide “essential” interventions to people throughout the world would cost $30 to $40 per person, or a total of $40-60 billion. The cumulative GDP of the 20 largest economies in the world is about $60 trillion. Therefore, it would cost 1¢ out of every $10 of GDP of those 20 countries to provide for the essential health needs of the entire world’s poor.

While in this country we may spend hundreds of thousands of dollars on a treatment for one person that gives them a few extra months of life, in an impoverished country an investment of as little as $25 per person per day  can raise the country’s life expectancy by more than a decade, or cut the mortality rate of children under age five by nearly 75%.

These facts bring up a lot of questions in my mind, such as, Should one’s access to basic health care be determined almost totally upon where one was born? Now that I know these things, should I, should we — as individuals, as a Christian community — be doing something more about them? Should healthcare aid come primarily from governments, from private citizens, or both? Is it our nation’s responsibility to help provide for the healthcare needs of the world’s poor when healthcare spending on our own population is driving us into bankruptcy?

Some abbreviated answers to the questions I posed: As followers of Christ in a “globalized” world, we should seek to redress injustice where we can, even in other countries. Not all inequalities are injustices, but healthcare is an important good upon which many other goods rest; and unequal access to the most basic goods of healthcare based solely on where one was born is an injustice and an affront to human dignity that should be amended. While we should not look exclusively to government to provide health assistance, $40-60 billion is a big chunk of change that will require government involvement to provide. (Perhaps this is a place where Christians savvy in bioethics and policy could make a difference by becoming involved in public policy surrounding foreign aid.) The fact that our country’s healthcare spending is driving us into bankruptcy should be a sign that our healthcare delivery is radically broken, driving us to take radical action to fix it, not keeping from providing aid to those who are in want of the most basic of care.



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