The Role of Developed Nations to Developing Nations
The Role of Developed Nations to Developing Nations
The Unspoken Dilemma of Inadequate Health Infrastructures in Developing Nations
An exploration of the ethical obligations of developed nations in ensuring the value of human life
By: Anyra Kapoor
Do developed nations have a responsibility to aid developing nations in issues that revolve around the right to health? Where does this obligation end? And most importantly, how do we go about achieving global health justice? These are all questions which revolve under the obligations of developed nations to developing nations. These questions are at the heart of global health justice, and the ways in which many nations do not have the infrastructures nor the capability to provide for the health of its citizens. Especially in an age of pandemics, it is imperative that we examine the lack of healthcare rights in many developing nations, and the ways in which these issues are interconnected with the global economic order. Therefore, this paper will examine these ethical dilemmas through the principle of justice, the values of responsibility and accountability, along with the concept of morality, in order to draw the conclusion the developed nations do have an obligation to help remedy the diminishment of health rights in developing nations as a means to ensure that the value of human life is treated equally on a global scale.
Table of Contents
- Current Economic Inequality in Developing Nations
- The Ebola Epidemic
- Justice: The Guiding Principle
- The Juxtaposition of Accountability and Autonomy
- Responsibility: The Vehicle to Global Health Justice
- Morality: Why are Global Health Inequalities Morally Disturbing
When news of the Ebola epidemic first reached countries outside of West Africa, developed countries were quick to mobilize resources and standard of care plans to combat the potential of the disease spreading to their shores. For example, several Americans infected with Ebola in West Africa were airlifted to the United States and treated with optimum medical care, including experimental therapies that had never been tested on humans. When comparing this response to the resources available in West Africa, it is evident that there was and still is an imbalance in health justice, leading to a corresponding lack of recognition surrounding global inequalities in health. However, the Ebola Epidemic serves as just one instance of the various ethical implications of developing countries having less resources to combat health epidemics. Rather, what the Ebola Epidemic more prominently exposes, is the inability of developed countries to fulfill their minimum obligation to provide and protect health for all as a matter of global health justice. It makes one think, at what point will failure to fulfill an obligation lead to the devaluing of human life for millions? And when, if ever, should developed countries recognize their privilege in having an abundance of resources which allows them more power, and work with the less fortunate to help lift them up to a standard of health adequate for the pursuit of flourishment?
This paper will focus on the ethical issue of global resource development and acquisition through the lens of epidemics in developing countries and their corresponding responses as a result of infrastructures and a lack of global health justice. These potential detrimental consequences and ethical implications will be examined using the principle of justice, the value of accountability and responsibility, along with the principle of morality and the concept of a slippery slope. The commonality between all of these principles and values is that they appeal more deeply to the human consciences and their ability to value agency over one’s health. Thus, after carefully evaluating the disregarded issue of global health justice when it comes to the protection of health rights for individuals in developing countries, I have drawn the conclusion that it is unethical for developed countries to not fulfill their minimum obligation in ensuring health rights, specifically the right to flourish for those in developing countries, as it is an utmost contradiction to the global fight for health justice and protection of human life.
Current Economic Inequality in Developing Nations
Firstly, I would like to provide a brief background on the current situation of healthcare systems and economic inequalities in developing countries, and the ways in which they work in tandem to produce a lack of health rights or accessibility for their citizens. A prominent example of a country with a lack of healthcare as a result of unregulated economic infrastructures, is that of Bangladesh. The combination of immoral practices within the factory system (the primary contributor to the economy of Bangladesh), and unregulated sectors creates an upward increase in expenses for the poor. Consequently, a rural-urban divide is formed within the society, with an additional lack of coordination among the institutions, whether economic or medical, which are propagating this system (Shafique). Since there is no regulation to preserve these already diminished systems, Bangladeshi citizens have virtually no access or right to health. The lens through which one can examine the reform needed to aid Bangladesh, is through the social determinants of health, which introduces the idea of universal health coverage and social justice. Social determinants of health are essentially conditions in the environment where people live, learn, work, and age that affect health. Examples of this are access to health care services, social norms, residential segregation, and socioeconomic conditions. Thus, in countries like Bangladesh, these determinants of health are not able to be met because there are no infrastructures which allow for these environments to pursue the health needs of their citizens. An option which has been proposed to remedy this, is Universal Health Coverage, as it aligns with the idea of social health justice as a means to ensure determinants to future health.
Next, I would like to explore the reasons as to why these economic and social barriers are so evident in developing countries, and our role as global citizens to acknowledge these failures within global health justice. Economic development in developing countries is first necessary to provide for the underlying determinants of health. Essentially, the current inequalities in power with the international economic order and spread of neoliberal policy limit the ability of developing states to develop economically (Fox). Therefore, in order to fully gain an understanding of the ethical aspects of global health justice through research development and acquisition of resources, one must also first acknowledge the global economic power dynamic. The lack of infrastructures in countries such as Bangladesh are a result of developed nations yielding their economic power in a way that exploits the nature of these countries to better themselves, such as in the case of the U.S. using Bangladesh as an outlet for factory products. Thus, these countries are unable to implement these health infrastructures not only because they don’t have a means to, but also because they are prevented from economically bettering themselves due to the ways in which developed countries profit off of their inferiority on the global scale.
The Ebola Epidemic
To guide my discussion and argument pertaining to global health justice through the development of healthcare infrastructures, I will look to the Ebola epidemic as an example of the failure to acknowledge these global health inequalities. In examining this case, it is imperative to first note that ethicists point out that what could have been an easily containable outbreak went out of control because of a lack of health infractures (Thompson). Therefore, a failure to recognize global inequalities in health as “urgent,” or worthy of our attention, is arguably the root cause of the EVD outbreak.
During the Ebola Epidemic, there were many ethical dilemmas which highlighted the inequalities present globally in health infrastructures. Firstly, there was the issue of equitable distribution of resources, and whether there should have been a risk to healthcare workers globally (healthcare workers going to West Africa to assist). Although there were many humanitarian organizations which provided a significant amount of care during this crisis, the need for them outstripped their ability to respond effectively (Thompson). Therefore, this understanding of equitable distribution of healthcare workers, and whether they should have been morally obliged to help in West Africa, highlights a need for global solidarity. If global solidarity among healthcare workers is established, as opposed to a “self-posed risk” mindset, then healthcare workers can ensure that countries have the ability to deal with outbreaks before they become pandemics.
“Perhaps the only good news from the Ebola Epidemic.. is that it may serve as a wakeup call: we must prepare for future epidemics of diseases that may spread more effectively than Ebola.” – Bill Gates (Ethics and Learning Lessons from Moral Failures: Who Cares About Ethics?)
Secondly, there was the issue of allocating resources based on nationality, and how this could prove detrimental to further research development and responses. As aforementioned, several of the Americans infected with Ebola in West Africa were airlifted to the United States and treated with optimum medical care. This included experimental therapies that had never been tested on humans (Blais). Ultimately, this example leads to the question of: Why should individuals get access to experimental therapies when others dying of EVD in West Africa do not? Perhaps more apparent than ever, this is an example of Western resources and development solely being instituted for one’s own citizens. Although this can be argued as benevolent, and simply a country’s obligation to their own citizens, it still disregards a global citizen outlook in examining healthcare and access to health for all those suffering in a time of crisis, due to the lack of infrastructures in the country they would reside in.
Lastly, there was also the issue of research for the treatment of Ebola, and who would participate in those trials. It was extremely likely that those who volunteered for the EVD vaccine trials would acquire EVD, hence, those who volunteered were much more likely to be healthcare workers (Folayan). As a result, healthcare workers faced increased risk of Ebola exposure and infection. This raised the ethical issue of standards of care for those who become infected. To further the point established previously pertaining to one’s nationality and the resources available to them, there was the ethical dilemma of how care would be handled if a healthcare worker from a developing country and one from a developed country contracted EVD (Folayan). In essence, is there justification for differential access to medical care in trial situations? Ultimately, I would state that justifying differential care based on nationality is unethical, but providing a higher standard of care to those in immediate communities (solely those in West Africa) is also inequitable, as it once again disregards a holistic understanding of those who are suffering. In examining any issues of health rights and the preservation of health, it is imperative that we don’t rank healthcare or status, in order to prevent the potential for a ranking of human life.
Justice: The Guiding Principle
The first principle, or value, I would like to use to examine this issue of global health justice and resource acquisition is that of justice. It is one of the most signficant, if not the most important value to consider in the evaluation of health infrastructures within developing countries.
Before I look at how justice is not being fulfilled, and the specific ways in which we can push for it, I assume, for the purposes of argument, that everyone has an obvious interest in improving health status and outcomes on a global scale.
Once we have established this, we have to look at the basis of what guarantees “justice.” For this, I consult the Universal Declaration of Human Rights, which states that everyone is equally entitled to the “potential to flourish.” Additionally, Article 25 states that “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….” If we examine this, then it is evident that everyone has the right to a standard of living which equates to a chance at health. Although this may seem more interconnected with economic issues relating to livelihoods, it also looks to the infrastructures and ability for one to maintain their health through systems which protect and provide for it. Thus, we must give all people a chance at health. Specifically, an equal chance at pursuing health. This specification is important to note, as although one might think a guaranteed right is sufficient, an individual still must have the support and capability to exercise that right through the implementation of systems or institutions which protect their right to health functioning and exercistion of agency.
Expanding further, in terms of global justice through a distributive lens, it is of utmost importance to first distribute the means for countries to empower themselves to achieve health justice, for example, through the implementation of health infrastructures and systems. In essence, one’s ability to pursue their own sense of agency and potential for health is only probable when countries have the resources to provide for this individual mission. As previously mentioned, aid and resources are only helpful if there are measures in place to uphold and distribute them, hence furthering the need to ensure an equal chance at pursuing one’s fullest capability to health. As we can see with the examples of Bangladesh and the Ebola Epidemic, this chance has been stripped away from people, as they are being deprived of their health capabilities. Furthermore, there is a value of health both intrinsically and instrumentally. All individuals should have equal capability to achieve health, which emphasizes an individual’s ability to be free of preventable morbidity and mortality (Ruger). Hence, deprivations are unjust because they reduce the capability for health functioning and exercisition of agency (Ruger). This is why the principle of justice appeals to all humans regardless of where they live, as this value of human life must be treated equally to avoid the threat to human flourishing.
Another way we can examine health justice is through a legal lens. Currently, there are little to no legal obligations or requirements to ensure global health justice, and sense of shared moral responsibility. In a sense, this lack of health justice can be seen as a failure to pay attention to public health, and a comment on society’s larger concentration on economic development. It is extremely evident that a focus on economic development as opposed to public health would be seen as a materialistic global motive, and unjust when examining the neglectance in developing infrastructures. Furthermore, we must also recognize that justice is not as simple as an allocation of resources. When examining disparities on a global scale, one might simply shift obligation and responsibility towards giving developing countries medical treatments or vaccines. However, ensuring access to vaccines is of limited use to low-income countries if they don’t have efficient systems in place to ensure an efficient distribution (Berman). Due to this, there is a heightened need for justice in health infrastructures to be achieved, as these are the issues that undermine the effectiveness of any treatments. One of the systems which has been proposed to address this issue is that of Global Health Law. Essentially, this would suggest a system which would organize the WHO into a larger global role, and allow for a legal system which would commit itself to primary health care for every person in the developing world (Berman). It would be reorganized around three major pillars that are central to guarantee this legal right of health: social infrastructures, proactive collective measures, and responsible individual interventions (Harmon).
Expanding on the aforementioned point regarding allocation of resources through distributive justice, these principles of health justice are truly only effective when rooted in the systems that can achieve these goals. It is important to distinguish between justice achieved through the means of individual obligation, and justice achieved through the implementation of institutions. By this framework, the obligation to ensure distributive justice as a means to allocate resources must be heavily placed on systems, as they are the ones which set up the regulation or practices for this to occur, while also protecting the standard for them in any given societal system or construct. Any reliance on an individual to ensure distributive justice would not only be unfeasible given the scale of the inequalities and injustice of this dilemma, but also ineffective in addressing the heart of the problem.
Finally, justice can be seen through a societal lens. We have to see that health justice is ultimately a global issue. Because of the globalization of pandemics and diseases, all health is ultimately interconnected. It would be unjust for us to simply turn a blind eye to the inequalities which deprive many people in developing countries of their right to health. If we as a society want to adhere to the pillar of justice, and the fundamental protection of all people, we must legally and societally enforce systems which will organize global health justice as a priority.
The Juxtaposition of Accountability and Autonomy
Next, I want to examine the interesting juxtaposition between accountability and autonomy, specifically accountability for those in developed nations, and the autonomy of these countries to decide if and how they want to assist on a global scale. To fully grasp the implications of accountability in global health justice, one must look at why accountability has been neglected. Historically, there has been a lack of political will to specify and enforce obligations for global distributive justice, and this has the result of negatively realizing the health rights for those in developing countries (Barugahare). Countries should be held accountable for this neglect and lack of initiative, as it is a real denial of this necessity.
Another way to examine this is by enforcing accountability through tangible obligations among governments. An exclusive reliance on voluntary philanthropy often has the problem of failing to equitably distribute the burdens of alleviating these issues and fixing these infrastructures (Barugahare). Therefore, we must move away from solely benevolence as a means to achieve this goal, and more so towards governance. Lastly, one must also see that global accountability is ultimately for one’s own benefit. As mentioned earlier, global response and preparedness is only as strong as its weakest link. Consequently, we must look at the idea of being a “global citizen,” and how these issues could decline to a point where we are devaluing human life because of an inherent lack of assertiveness when aiming to solve these inequalities.
However, one of the main counterarguments to this view of shared responsibility and accountability, is that of a country’s individual autonomy. This can be traced to national sovereignty and autonomy, as countries are unwilling to give up their freedom in deciding how to manage domestic affairs. Furthermore, they can remove themselves from this issue by asserting their own national interest, stating that this global issue is not of benefit to them (Barugahare). However, I would argue that this is simply a sign of inherent disregard for justice and an acknowledgment of the health rights of other countries. Whether in the Ebola epidemic or currently in Covid-19, one must see that health is a universal right that should be protected in order to avoid the potential of determining which lives are inherently more valuable. Furthermore, the significance of national autonomy in a discussion surrounding global health justice also fails due to the benefit of global justice to all countries. It is within a country’s own national interest to promote global health justice, as a lack of international global health hurts everyone in an age of pandemics and interconnection of diseases.
Responsibility: The Vehicle to Global Health Justice
Another value to keep in mind in the discussion surrounding global health justice and accountability, is that of responsibility. There are many responsibilities which must be accounted for in order to ensure an ethical process in protecting this right. As briefly touched on before, there is a sense of global responsibility, perhaps more prominently placed on the developed countries, to take initiative in creating systems which will give justice to those being deprived of their right to “flourishment.” This responsibility can be simply defined as a responsibility to protect health rights, as opposed to a self-centered view of a responsibility to help others because one is more advantaged. Additionally, it is important to be wary of descending down the slippery slope of feeling “burden” by the goal to achieve health rights for all people, and that this could diminish a developed country’s power and influence. Some might argue, in relation to colonialism and the global scale, that developed countries wouldn’t agree to provide more stable and predictable health funding in the long term, as this could weaken their influence on the recipient countries. However, I personally believe that countries should recognize this as self-interest, and try to fulfill their responsibility in reducing global health inequalities. An example of this responsibility can be seen through the concept of “shared responsibility,” which necessitates collaboration and the sharing of information and resources (Smith). To some extent, this notion would imply that companies or pharmaceutical companies would be required to share their discoveries with the larger global community to ensure that all have equal access to information and resources. However, this would raise the ethical dilemma of ownership over one’s own products. For this reason, it would be more productive to establish “shared responsibility” as a collaborative effort rooted in global discussion and information, as opposed to a more materialistic interpretation regarding resources and developments. This would effectively set the foundation for equality when faced with solving these global health inequalities, and prevent exploitation and large inequity in the global power scale, as everyone would have some shared basis for information.
The other lens one can look at responsibility through, is that of ensuring ethical treatment of developing countries in implementing these research and development processes. First and foremost, developed countries have an obligation to ensure informed consent in international research. There are many factors which differ between developing and developed countries, primarily within decision making. The basis of decision making in Western countries is that of autonomy of the individual and informed consent; this is often accepted as a right (Krogstad). On the contrary, in developing countries, a sense of communal decision making is often very frequent. This means that in decisions regarding health, less emphasis is given to individual autonomy (Krogstad). For this reason, we must be sure to acknowledge cultural decisions while still informing participants of the implications of research. There is a fine line between helping and imposing one’s views, and we must always respect decisions made by others even if we culturally disagree with them. Regardless of our perceptions about individual autonomy, we must also look at others’ societal understandings of it, and see the potential for a slippery slope if we were to impose our own practices on others. Additionally, we must prevent exploitation by implementing safeguards which will protect against potential questioning of “regular norms,” and allow for the individuals and developing countries to still have a sense of individuality and autonomy when concerning these decisions (Oguz). The primary goal is to improve health infrastructures and conduct research in a way that is not damaging to a country’s character and autonomy as a society, but rather furthers their ability to flourish in health.
Naturally, I realize that during this analysis of responsibility and accountability, one might ask: Where does this end? Do countries have a continuous responsibility to intervene within developing countries to ensure their right to health? In answering this question, it is important to make a significant distinction. There is a large difference in acting to protect health rights through benevolent means, as health has an underlying universal standard, versus impeding on another’s values and principles. This point establishes the concept of undue influence. If one developed nation has done its role in implementing and supporting an infrastructure that will provide and protect the health rights of those citizens, then there is no moral or ethical need to further impose within the country. In essence, although a developed nation may wish to spread a certain value or doctrine, or further their own economic or political agenda within the country, they are morally and ethically obligated not to pursue that line of reasoning. If one were to further influence another country and essentially impede on their autonomy and sovereignty, then developed nations would be descending down the slope of paternalism under the guise of global responsibility. It is evident that this methodology has been used in the past as a means to justify intervention, as seen with the “White Man’s Burden,” thus, in the context of health rights and relationships between nations in general, it would be wholly unethical and immoral to continuously impede on a country in affairs which do not relate to the health of citizens and the protection of those rights.
Morality: Why are Global Health Inequalities Morally Disturbing?
Finally, after an examination of all the ethical implications of these issues, one can even take a step further and look at health through morality. Ethics should guide our discussion surrounding justice, but morality can guide our discussion surrounding the prevalence and need for these health rights and protection. In other words, ethical loopholes are important to point out when exploring disparities between health infrastructures, but moral issues can take it a step further when examining the fundamental rights of humans and the ways in which they are disregarded due to lack of action and privilege. To start, basic capabilities such as health are associated with basic needs. As a result, health is a prerequisite to other capabilities, and therefore have particular moral and political importance when attempting to fulfill these “urgent claims” (Ruger). From a moral lense, this notion implies that society should create conditions for individuals to achieve a certain level of functioning. This approach doesn’t seek to find ways where global and national actors deal with global health injustices, but rather endorses a moral concept of human flourishing where everyone has the right to be healthy (Ruger).
Inequalities are ultimately morally troubling because our intuition and ethical claim of equal respect for all humans tells us that being born into a country where one has a good chance of being in the worse-off health status or “group” is morally arbitrary and requires rectification (Ruger). Hence, moral arbitrariness should not be the basis for determining health or survival, as no one has control over the geographical situation they are born into. In a society where it is easy to fall into privilege and remove ourselves from inequalities and injustices, we must be even more aware of the moral implications of inaction and silence. One can even examine privilege as a result of the exploitation of developing countries. Western powers, as touched on before, benefit from the lack of infrastructures present in developing countries, as they can benefit off of the cheap labor and resources which those countries offer. This prevents them from pursuing an economy which will endow the flourishing of their citizens, and thus, diminishes their value of life.
While trying to achieve global health justice, we must also see how global health inequalities, as they currently stand, don’t provide any moral motive for remedy. Hence, we need to ground our discussion in morality, so that we see this as an obligation owed to our global citizens and see the moral justification to reduce these inequalities.
The globalization of the current world demonstrates that we cannot afford to privilege and prioritize certain communities over others, as it will eventually loop back to the issue of health rights and health capabilities of people in various countries. I firmly believe we must shift away from a nationalistic percpetion of protecting human rights to that of being a “global citizen,” and recognize that the compromisation of health and the ability to “flourish” in many countries is due to the inequalities within health infrastructures. Furthermore, as developed countries, we cannot afford to turn a “blind eye” to these issues, as a threat to health rights in one country is a threat to health rights everywhere. Especially in an age of global health pandemics, our response and ability to preserve and react is only as strong as our weakest link. Thus, developed nations have an ethical and moral obligation to ensure and protect health rights in developing nations.
The values of justices, responsibility, accountability and autonomy all heavily influence the ways in which we should streamline the discussion surrounding global health justice and perhaps even the possibility of Global Health Law as a means to ensure tangible action. To take it a step further, we can even look at the fundamental component of morality, and how we as humans must preserve our own moral compass when examining inequalities and the disparities among various countries. Ultimately, we must find a way to be just, while also keeping in mind our responsibility to better these infrastructures, not culturally impose on them, finally creating a global society in which the value of human life is equivalent, and everyone has an equal opportunity to pursue health and the concept of “flourishing.” If we do not make this our priority now, we will only react as opposed to preventing future health crises, something which could have a large detrimental consequence on the global nature and perception of human life than ever before.