Health and Global Justice problem scope

The scope of the problem
• We were discussing global inequality in the context of basic
• It is obvious that having lower SES seriously undermines the
ability of people to address these basic rights
o Life expectancy in Swaziland is half that in Japan (People Facts and Figures:
Life Expectancy 2005).
o A child born in Angola has seventy-three times as great a chance of dying
before age five as a child born in Norway (UNICEF 2000).
o The likelihood of dying during childbirth in southern sub-Saharan Africa is 100
times higher than in an industrialized country (World Health
Organization/UNICEF/UNFPA 2005).
• Again, we can approach the question of health and social
justice by looking at different dimensions:
o Response vs prevention;
o Compatriots vs non-compatriots responsibilities (similar to what we
discussed in migration) BUT
• The global health status would be probably the core
The scope of the problem
• When we look at global health We may probably
broadly distinct between the range of health relating
social justice problems due to globalization as:
• Discriminatory practices of global corporations &
intellectual property regimes and
• Global arrangements that limit the likelihood of low
income countries to address health concerns
o “Brain drain” in the field of health care is one of the problems that may be
posing the greatest challenge for social justice
Discriminatory practices
• Discriminatory practices of global corporations: unethical
clinical trials
• India:
o The revenue of drug testing companies has grown from $485 million in 2010-11 to
over $1 billion in 2018
o Revenues of pharmaceutical corporations outsources trials are many times higher
o January 2005 – November 2017, 4,967 people died during the course of drug trials
and research
o Some 20,000-odd people have suffered adverse reactions in such trials
• People have to fight for compensations (The National, Sept.
17, 2018)
• India is an example of the current trend where expensive
and highly regulated in high income countries clinical
countries are outsources to low income countries
• In low income countries clinical trials are often the only
opportunity to access modern medication but
• The trials are usually poorly regulated
Intellectual property regimes
• Intellectual property regimes:
• Approximately 1.6 million Africans died of malaria,
tuberculosis and HIV-related illnesses in 2015.
• Globally, 50% of children under five who die of
pneumonia, diarrhoea, measles, HIV, tuberculosis and
malaria are in Africa (WHO)
• One of the central problems is lack of medication:
o For example, in some parts of Zimbabwe some nurses
give painkillers to sick patients as a “treat-all drug”
• Less than 2% of drugs consumed in Africa are
produced on the continent
Intellectual property regimes
• Constraining factors:
o The Trade Related Aspects of Intellectual Property Rights (TRIPS)
regulation of the World Trade Organization (WTO),
o in force since 1986,
o curtails the right of companies to manufacture generic drugs,
forcing countries to rely on brand-name products.
• The cost of advanced HIV/AIDS medication could be
same as in high income countries (clinical trials are
often done in low income countries)
Brain drain problem
• We discussed this problem when we were talking about
migration in general
• What happens in the field of health care?
• High income countries vs. low income countries:
• Migration of health care professionals happens in both
high income countries & low income countries
• The social justice concerns are about the implications
• Less severe in high income countries:
o a) more or less working system already exists, and
o b) the number of professionals who remain in the country is more or less
• This is not the case in low income countries, therefore,
negative effect of brain drain is much more pronounced
in low income countries.
Brain drain problem
• Africa (with high health needs and problems): some 23,000
qualified academic professionals emigrate annually.
• Zambia: out of 600 doctors trained in the country since
independence only 50 remained in the country (Bundred and
Levitt 2000: 245–6).
• South Africa: between a third to a half of medical schools
graduates emigrate to high income countries
o “The loss of nurses has been even more extreme – for example, more than 150,000
Filipino nurses and 18,000 Zimbabwean nurses work abroad. A recent report from the
United Kingdom estimated that 31% of its doctors and 13% of its nurses are born
overseas […]. These reported figures are likely to be underestimates as many migrate
unofficially. (Pang et al. 2002: 299–300)”
• Annual loss of nurses in some countries is higher than the rate
of training
• For instance, in 2001 Ghana lost 500 nurses twice the number
of trained that year (The World Bank, American Federation of
Teachers 2003).”
Brain drain problem
• Cumulative effects:
• Many countries project shortages of health workers
• Yet, effects on sub-Saharan Africa are particularly
• Current shortage is about one million health workers
required to meet the Millennium Development Goals by
• Further loss effects:
• Obvious:
• further loss of health services and decreased levels of
• Less obvious:
• Affected countries can’t utilize available aid – billions of
dollars to address global health problems, such as
HIV/AIDS – due to lack of health care professionals
(British Medical Association 2005).
Brain drain problem
• Reasons for brain drain
• Perception of better economic and professional
opportunities in high income countries
• Aggressive recruitment practices by reps. of high
income countries
o Often recruitment agencies operate on
Brain drain problem
• Brain gain phenomenon:
• As we already know we have to use differential approach
towards the issue of brain drain.
• In fact, the effects are country specific.
• For instance, in the Philippines training of nurses for foreign
markets is a strategy in the globalized world
• Trained workers than send remittances back home to support
families, but
• Cases like Filipins are more an exception than a rule
• The effects on vast majority of developing countries is
• African countries are among the most negatively affected:
o “the hemorrhage of health professionals from African
countries is easily the single most serious human resource
problem facing health ministries today” (Sanders et al. 2003).
Distribution of health care
• From the social justice perspective serious concern is
inequality in the distribution of healthcare professionals
• Current distribution of healthcare professionals:
% of world’s
% of world’s health
Europe and North
21% 45% (doctors)
61% (nurses)
Africa 13% 3% (doctors)
5% (nurses)
Distribution of health care
# healthcare professionals
per 1,000
Required ratio for basic healthcare provision 2.5
Actual ratio
Europe 10.3
Africa 1.4
# doctors per 1,000 (Sanders et al. 2003)
WHO target 1
Actual ratio
Wealthy countries 2
25 poorest countries .04 (1 per 25,000)

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