Global Inequality & Access to Health Care
posted by Frank Pasquale
According to a recent study in The Lancet, “The world’s wealthiest two billion people get 75 percent of all the surgery done each year, while the poorest two billion get only 4 percent and often die or live in misery as a result.” It’s a striking fact; how are we to interpret it?
There are two metanarrative accounts of the relationship between inequality and health care. On a Whiggish, optimistic view, vast inequality can generate the capital necessary to fund investment in innovative health care technologies. Scholars like Richard Epstein have celebrated both general economic inequality and unequal access to health care particularly because, they claim, buying power at the top promotes investment in medical advances. On this view, innovations in the wealthy world can diffuse throughout lesser developed regions. Moreover, the rich can also subsidize the poor locally, paying for infrastructure that serves a broader community.
Interpreted less charitably, inequality enables the well-off to bid away resources and opportunities from the poor. Richer nations and persons may snap up limited resources; for instance, in 2009, Jeanne Whalen at the Wall Street Journal wrote an article entitled Rich Nations Lock In Flu Vaccine as Poor Ones Fret:
A scramble among wealthy nations to guard against a swine-flu pandemic is raising concerns that billions of people in poorer countries could be left without adequate supplies of vaccine. . . . The emerging battle between the haves and have-nots underscores a major weakness in the global health system: Pharmaceutical companies have severely limited capacity to produce flu vaccines in emergencies.
Inequalities can be even more stark at the R&D phase. If an anti-baldness cure can generate billions of dollars in revenue while a new therapy for tuberculosis only generates hundreds of millions, for-profit pharmaceutical companies may well have a fiduciary duty to invest scarce research dollars in the unhirsute rather than the truly unhealthy.
Lawrence Gostin’s recent article “Redressing the Unconscionable Global Health Gap” offers some practical ways of addressing these disparities:
The international community is deeply resistant to taking bold remedial action — more concerned with their geostrategic interests than the health of the poor. The scale of foreign aid is both insufficient and unsustainable and fails to address the key determinants of health. As a result, the world’s distribution of the “good” of human health remains fundamentally unfair, causing enormous physical and mental suffering by those who experience the compounding disadvantages of poverty and ill health.
In this article, I propose an international call to action through the adoption of a Global Plan for Justice (GPJ) – a voluntary compact among states and their partners in business, philanthropy, and civil society to redress health inequalities. The GPJ would be a form of “soft” norm setting, rather than a legally binding treaty, achieved with the passage of a World Health Assembly resolution.
Lest we dismiss such inequalities as “not our problem,” Thomas Pogge’s sobering new book elaborates on his earlier argument that wealthier nations are responsible for the plight of the poorest:
[P]olitical and economic inequalities are rising dramatically both intra-nationally and globally. The affluent states and the international organizations they control knowingly contribute greatly to these evils — selfishly promoting rules and policies harmful to the poor while hypocritically pretending to set and promote ambitious development goals.
Both Pogge and Gostin’s work should guide policy responses to the extraordinary disparities exemplified in the Lancet story. As I continue to study fractal inequality in access to medicine, I will be sure to consult their proposals for a more just world. I also hope to see proposals for taxation of “medical tourism” that would redirect at least some of the funds from overseas patients to infrastructure that would support underserved patients in the regions they visit.
Image Credit: Cover for Peter Unger’s book, Living High & Letting Die, discussed here.
X-Posted: Health Reform Watch.
July 27, 2010 at 9:23 am
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Responses (3)
Maryland Conservatarian - July 27, 2010 at 11:53 am
Assuming a finite supply of a health good such as, say, a vaccine, wouldn’t re-directing those goods to poorer consumers just mean taking them from other people – with the net result being the same amount of people served and the producer just paid less for her (see, I can be self-consciously PC) efforts.
Wealth is created…and the surest way to cease such creative efforts is to have a bunch of self-styled elites swoop in after the fact to determine the “fairest” way to use that wealth. As the Rev. Ike used to say, the best thing you can do for the poor is not to become one of them.
Jimbino - July 28, 2010 at 12:14 pm
Lots of problems with this analysis!
First, when the rich bid healthcare resources from the poor, the poor get things they value more–jobs, food on the table, kid’s education–in return. Prohibiting or taxing such “bidding” only leads to a smaller pie, flight of the resources of the rich, fewer jobs for the poor, and class warfare.
Secondly, the poor would benefit from elimination of the plethora of government policies that hobble, tax and exploit them, including the minimum wage, unionism, certification of teachers, lawyers and medical professionals, maintenance of parks and forests the poor never visit, cotton and peanut price controls, farm subsidies, ethanol subsidies and so on. The government, not the rich, is the chief actor in maintaining the misery of the poor.
Taxing medical tourism is a joke, since now under Medicare and in the future under Obamacare, there is no provision for expatriates who enjoy cheaper medical care overseas to escape the taxes for USSA care that they cannot participate in.
Patrick S. O'Donnell - July 28, 2010 at 1:22 pm
Jimbino,
You might take the time to familiarize yourself with the relevant literature. You could do worse than begin here: http://ratiojuris.blogspot.com/2008/11/health-law-ethics-social-justice-basic.html
If you miss the bibliography in the above post, it’s here: http://www.jurisdynamics.net/files/documents/HealthandSocialJusticeBibliography.doc
Finally, see too this post at your favorite blog: http://www.religiousleftlaw.com/2010/03/justice-inequality-health.html
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