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International Justice and Health: A Proposal

Published online by Cambridge University Press:  28 September 2012

Gopal Sreenivasan
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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

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References

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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.

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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.

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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.