Transcript Slide 1

Summerschool Health law and ethics
Erasmus University Rotterdam, July 2009
Social responsibility and
health
Article 14:
1. The promotion of health and social development for
their people is a central purpose of governments
that all sectors of society share.
Social responsibility and health
Article 14:
2. Taking into account that the enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human being without
distinction of race, religion, political belief, economic or social condition,
progress in science and technology should advance:
a. access to quality health care and essential medicines, especially for the health
of women and children, because health is essential to life itself and must be
considered to be a social and human good;
b. access to adequate nutrition and water;
c. improvement of living conditions and the environment;
d. elimination of the marginalization and the exclusion of persons on the basis of
any grounds;
e. reduction of poverty and illiteracy
Social responsibility and health
OUTLINE
1. Highest attainable standard of health as a fundamental
human right
2. Health and the impact of social and overall living
conditions
3. The state of health today – the social context of health
4. Duties and responsibilities
5. Health and contemporary challenges to social justice
Social responsibility and health
1. Highest attainable standard of health as a fundamental human right
Universal Declaration of Human Rights, 1948:
Article 25.
(1) Everyone has the right to a standard of living adequate
for the health and well-being of himself and of his family,
including food, clothing, housing and medical care and
necessary social services, and the right to security in the
event of unemployment, sickness, disability, widowhood,
old age or other lack of livelihood in circumstances beyond
his control.
Social responsibility and health
1. Highest attainable standard of health as a fundamental human right
Constitution of the World Health Organization, 1946:
The enjoyment of the highest attainable standard of health is
one of the fundamental rights of every human being without
distinction of race, religion, political belief, economic or
social condition.
Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity.
Social responsibility and health
1. Highest attainable standard of health as a fundamental human right
International Covenant on Economic, Social and Cultural
Rights, 1966
Article 15
1. The States Parties to the present Covenant recognize the right of everyone:
(b) To enjoy the benefits of scientific progress and its applications;
Social responsibility and health
1. Highest attainable standard of health as a fundamental human right
International Covenant on Economic, Social and Cultural
Rights, 1966
Article 12
1. The States Parties to the present Covenant recognize the right of everyone to the
enjoyment of the highest attainable standard of physical and mental health.
2. The steps to be taken by the States Parties to the present Covenant to achieve the
full realization of this right shall include those necessary for:
(a) The provision for the reduction of the stillbirth-rate and of infant mortality and
for the healthy development of the child;
(b) The improvement of all aspects of environmental and industrial hygiene;
(c) The prevention, treatment and control of epidemic, endemic, occupational and
other diseases;
(d) The creation of conditions which would assure to all medical service and medical
attention in the event of sickness.
Social responsibility and health
2. Health and the impact of social and overall living conditions
- Health care initiatives need to take into account the broad development
context
- Reduction of poverty
- Stewardship of the environment
Health as
- Assurance of human rights
- a means to other development goals
- Gender equity
- as an end in itself
- Global security
Social responsibility and health
2. Health and the impact of social and overall living conditions
- Ethical significance of public and population health initiatives
synergistic relationship between health and other aspects of
development
- poverty undermines a range of human capabilities including health
- need to reduces the burden of excess mortality and morbidity
suffered by poor populations
- sensitivity of health to the social environment and the ‘social
determinants of health
- inequalities between men and women, regions, ethnic groups, rural
and urban areas
Social responsibility and health
3. The state of health today – the social context of health
Among ca. 6800 million human beings, about
800 million are undernourished (UNDP 2007, p. 90), 1 bn now (FAO)
2000 million lack access to essential drugs
(www.fic.nih.gov/about/plan/exec_summary.htm),
1085 million lack access to safe drinking water (UNDP 2007, p. 254),
1000 million lack adequate shelter (UNDP 1998, p. 49),
2000 million have no electricity (UNDP 2007, p. 305),
2600 million lack adequate sanitation (UNDP 2007, p. 254),
774 million adults are illiterate (www.uis.unesco.org),
211 million children (aged 5 to 17) do wage work outside their household — often under
slavery-like and hazardous conditions: as soldiers, prostitutes or domestic servants, or in
agriculture, construction, textile or carpet production (ILO: The End of Child Labour, Within
Reach, 2006, pp. 9, 11, 17-18).
Social responsibility and health
3. The state of health today – the social context of health
Poverty-related causes of human death
- 18 million per year (out of 57)
- or 50 000 per day
Cheaply preventable through safe
drinking water, better sanitation,
more adequate nutrition,
rehydration packs, vaccines or other
medicines
WHO: World Health Report 2004
Respiratory infections, mainly pneumonia
3 963 000
HIV/AIDS
2 777 000
Perinatal conditions
2 462 000
Diarrhea
1 798 000
Tuberculosis
1 566 000
Malaria
1 272 000
Childhood diseases (mainly measles)
1 124 000
Malnutrition
485 000
11
Millions of deaths
Worldwide
Worldwidepoverty
Poverty
deaths
Deaths1990-2008
1990-2008
300
>300
WorldWar
WarTwo
Two
World
1939-45
1939-1945
Mao's
Great
Leap
Mao’s
Great
Leap
Forward
1959-62
Forward 1959-62
Stalin's Repression
Repression
Stalin’s
1924-53
1924-53
WorldWar
War
One
World
One
1914-18
1914-1918
RussianCivil
CivilWar
War
Russian
1917-22
1917-22
CongoFree
FreeState
State
Congo
1886-1908
1886-1908
55
55
30
30
20
20
15
15
9
9
7.5
7.5
Korea and Vietnam
Korea
and Vietnam
1951-54, 1965-74
1951-54,1965-74
5.5
5.5
00
50
50
100
100
150
150
200
200
250
250
300
300
Differences in the world
Least developed
countries
Less developed
countries
High developed
countries
GNP per capita (US $)
1,524
5, 430
26,395
Infant mortality
94
60
7
Life expectancy (yr)
51
64
76
Maternal mortality (per
100.000 births)
950
202
8
Fertility rate
5.1
2.9
1.6
Births per 1000 women 1519 yrs
119
61
26
Female adult illiteracy (%)
62
18
0
(Human Development Report, 2005. New York)
Shares of Global Wealth
2000; poorest versus richest households
1.9%
1.9%
4.2%
th Percentile
Up to
Up
to6060th
Percentile
($645
average)
($645 average)
8.8%
60th-80th Percentile
60th-80th
Percentile
($4,277 average)
($4,277
average)
80th-90th Percentile
80th-90th
Percentile
($17,924 average)
($17,924
average)
39.9%
15%
90th-95th Percentile
90th-95th
Percentile
($59,068 average)
($59,068
average)
95th-99th Percentile
95th-99th
Percentile
($156,326 average)
($156,326
average)
Top One
One Percent
Top
Percent
($812,693 average)
($812,693
average)
30.7%
Global Wealth Inequality
At current exchange rates,
the poorest half of the world’s
population, some 3,400 million
people, have about 1 percent of
global wealth ― as against 3
percent owned by the world’s 1125
billionaires.
Global Income Inequality
At current exchange rates, the poorest
half of world population, some 3,400
million people, have less than 3% of
world income ― as against 6%
received by the most affluent one
percent of US households consisting of
3 million people.
Shares of Global Income
2005; poorest households versus richest countries
1%
1%
20%
20%
Thepoorest
poorest households
The
households
(40%
of
humankind)
(40% of humankind)
Therichest
richest countries
(16%
The
countries
of humankind
(16%
of humankind)
Others (44% of
Others (44% of
humankind)
humankind)
79%
79%
Social responsibility and health
4. Duties and responsibilities
Responsibility
1. The state of being responsible, accountable, or answerable.
Responsibility is a heavy burden.
2. A duty, obligation or liability for which someone is held accountable.
Why didn't you clean the house? That was your responsibility!
The responsibility of the great states is to serve and not to
dominate the world (Harry S. Truman)
Social responsibility and health
4. Duties and responsibilities
Responsibility
• Insofar as health status is not
affected by human action,
no one is responsible for
them
• Insofar as deterioration of health
status is avoidable through
active intervention
• Insofar as deterioration of health
status is caused or
aggravated through active
intervention
acting
Positive
responsibility
Negative
responsibility
refrain
from
acting
Social responsibility and health
4. Duties and responsibilities
Duties
- Positive duties
we need to provide assistance, be active in order to contribute to
the improvement of global health, e.g. through helping to establish
social arrangements that will alleviate health deterioration
- Negative duties
we need to refrain for interventions, we must not contribute to
designing or imposing social arrangements that contribute to
deterioration of global health
Social responsibility and health
4. Duties and responsibilities
Types of duties
a. Imperfect duties
-
Duties beyond the constraints and obligations determined by law
-
Duties of beneficence: morally binding for individuals but they cannot be
demanded or imposed by others
-
Moral duties, irrespective of some kind of (human) rights
-
Example: duties of good citizenship; solidarity
b. Perfect duties
-
Duties determined by law
-
Duties of justice
-
Public; they can be demanded by the State
-
Correlative to the rights of others
-
Example: paying taxes
Social responsibility and health
4. Duties and responsibilities
‘social responsibility’
- Notion of responsibility extended from individuals to groups, communities,
institutions and corporations
- Groups, communities, institutions and corporations have moral duties that
go beyond what is legally required
- Social responsibility is connected to the moral vocabulary of imperfect
duties: they have duties that cannot be imposed by others or are
legally required.
- Social responsibility can be negative or positive: can go together with
negative duties (refrain from acting) and positive duties (acting is
required)
Social responsibility and health
4. Duties and responsibilities
‘social responsibility’ at different levels
The degree of responsibility increases as one’s amount of control over a
given situation rises
-
responsibilities of governments
- primary duty is to uphold and protect the rights of its citizens
- to provide the environment that could maximize the contributions of
other sectors
-
responsibilities of the health sector and the medical profession
-
responsibility of the private sector and industry
Social responsibility and health
4. Duties and responsibilities
responsibility of the private sector and industry
An example: United Nations Global Compact
Corporate social
responsibility
From the website (http://www.unglobalcompact.org):
The UN Global Compact is a strategic policy initiative for businesses that
are committed to aligning their operations and strategies with ten
universally accepted principles in the areas of human rights, labour,
environment and anti-corruption. By doing so, business, as a primary agent
driving globalization, can help ensure that markets, commerce, technology
and finance advance in ways that benefit economies and societies
everywhere.
over 4700 corporate participants and stakeholders from over 130 countries
Social responsibility and health
5. Health and contemporary challenges to social justice
a. Access to essential drugs and health services
More than 33% of the global population has no access to essential
drugs
The development of drugs for tropical diseases has progressed very
little
Even when drugs are available, they are often inaccessible for those
who need them most
b. Poverty and the HIV/AIDS pandemic
HIV/AIDS spreads more rapidly in poor countries and among poor
people
Social responsibility and health
5. Health and contemporary challenges to social justice
c. Standard of care international health research
Migration of research to developing countries without addressing the
needs of those countries
Need to develop local expertise and address local problems
Brain drain
d. The protection of vulnerable populations
e. Research prioritization
Global health research funding: only 10% of research resources
address the needs of the developing world
Research projects carried out in poor countries should be relevant to
their needs; participants should be regarded as stakeholders in the
research projects
Social responsibility and health
5. Health and contemporary challenges to social justice
f. Providing health care services across national boundaries
alarming migration of doctors and other health care workers
g. Organ transplantation and medical tourism
ongoing practice of transplanting organs from the poor to the rich
medical tourism industry: disguising the injustices associated with
transnational exploitation
Social responsibility and health
Conclusion
- a new principle with far reaching implications for the
agenda of global bioethics
- many issues and implications need further analysis
and research
- there is a wealth of data concerning problems and
issues to be addressed but a lack of illuminating
examples, successful cases and best practices
showing effective policies and good solutions