Public health, beneficence and cosmopolitan justice

Abstract

This article proposes that, in line with moral-cosmopolitan theorists, affluent nations have an obligation, founded in justice and not merely altruism or beneficence, to share the responsibility of the burden of public health implementation in low income contexts. The current Ebola epidemic highlights the fact that countries with under-developed health systems and limited resources cannot cope with a significant and sudden health threat. The link between burden of disease, adverse factors in the social environment and poverty is well established and confirmed by the 2008 World Health Organization’s (WHO) Social Determinants of Health Commission report. Well-resourced nations generally consider that they have some humanitarian obligation do assist where possible, but this obligation is limited. The following questions are considered: Is reliance on the principle of beneficence to address the global disparities in the social determinants of health and life expectancy at birth good enough? Do well-resourced nations have some obligation from justice, which is stronger than from beneficence, and which cannot be as easily cast aside or diminished, to address these issues? In a globalised world, shaped by centuries of historical injustice and where first world economies are now so intertwined and reliant on third-world labour, beneficence is not a strong enough principle to base an obligation to achieve the WHO vision of ‘health equity through action on the social determinants of health’.