On Monday evening, Georgetown Law celebrated the launch of O’Neill Institute Faculty Director, Lawrence Gostin’s new book Global Health Law. At the event, Ezekiel Emanuel, Laurie Garrett, and Edith Brown Weiss joined a panel, moderated by Gostin, to discuss the book and broader themes of global health and justice. This post provides a brief recap of the event.
The event began with Gostin discussing two competing narratives in global health. First is the narrative put forward by global health “heavyweights” such as Margaret Chan and Bill Gates, which lauds the considerable achievements over the past decades (e.g. greater access to basic health services, huge expansion of access antiretroviral therapy, etc.). The other narrative is advanced largely by civil society groups and focuses on the continued misery and ill health in which many still live. He illustrated this second theme by reading a selection of “global health narratives” from his book—stories of marginalized youth around the world.
Laurie Garrett began the panel discussion by considering where the “coming plague” might originate. She began by noting that we have a highly effective toolbox of interventions allowing us to counteract infectious disease. These tools are neither costly nor high-tech. However, they remain out of reach in much of the world. Garrett next turned to a few macro trends likely to spur the rise of new infectious disease threats including climate change, food insecurity, and the misuse of antimicrobials. She also noted how humans’ intrusion into and alteration of the natural environment is putting us into contact with a range of new vectors, resulting in an expanding array of emerging diseases, such as Ebola, Marburg, and many others. While it is impossible to say “this microbe is the one,” she concluded somberly, “There will be one…and we won’t be ready.”
Ezekiel Emanuel then turned to priorities in health and the allocation of resources. He began by asking whether, in a world of scarce resources for health and development (a reality he argued is not likely to change in the near term), “Are we getting the biggest bang for our dollar?” In response to this reality, Emanuel proposed a “principle of progress,” which focuses on improving the lives and health of those worst-off. Focusing on the bottom, he argued, is the fastest way to fill the glass. Gostin agreed, referencing a discussion he had had with a group of bioethecists. When asked whether it would be ethically justifiable to create an intervention that brought down tobacco consumption primarily among higher-income people, but where some benefit was also seen in low-income and minority communities, the bioethicists generally thought this was an overall good. Gostin, however, signaled his agreement with Emanuel that it would be unjust.
Edith Brown Weiss was asked about the impact of climate change on health. She first referenced the expansion of refugee populations that climate change was likely to cause. These refugees, in turn, would suffer from substandard sanitation and a lack of food, causing a surge of infectious disease, malnutrition, and other harms. She also predicted climate change’s impact on the distribution of infectious disease, moving some diseases into new vectors (e.g. malaria into warmer climates or Dengue Fever into the United States). She concluded with a discussion of the harms, both acute (dehydration and resorting to unsanitary sources) and long-term (e.g. food shortages), water shortages resulting from climate change would cause.
Finally, the panelists discussed how growing wealth disparities impacted health. Garrett pointed out that for most of the macro trends discussed, the wealthy have less need to be concerned, as they’ll have the resources to avoid the consequences. For instance, while climate change will be deadly for the poor, for the wealthy it is more likely to be an inconvenience. She also pointed to studies showing that wealth gaps within countries directly correlate to the level of basic health services (and health outcomes) in a society. Emanuel went further, showing that even entitlements to health care are not curative in the face of wealth gaps. Even with universal coverage, countries will face decreased funding for services if the wealthy have little incentive to fund universal coverage and low-income individuals have little political power. He also worried about a future in which the wealth gap between developing and developed countries narrows, but the gap within countries expands. Finally, Weiss noted that many of the issues raised return to a fundamental issue of implementation. By focusing on bottom-up implementation, having a meaningful impact is more likely.
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.