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This chapter discusses challenges of global health inequalities in the current global health policy system. It then describes provincial globalism and a shared health governance framework as approaches to these challenges. Moral philosophers have for some time argued that global poverty and associated human suffering are universal concerns and that there is a moral obligation, beyond matters of charity, for wealthier countries to do more. Being serious about addressing the problem of global health inequalities requires developing a conception of global health justice. Moreover, addressing global health inequalities requires a reexamination of the norms and principles underlying global institutions in order to offer proposals for a better global health policy. This chapter sketches analytical components of provincial globalism, a framework that takes individuals to be the moral unit in both domestic and global contexts and that improves the prospects of alleviating global health inequalities. Provincial globalism promotes the realization of individuals’ health capabilities and supports a shared health governance that enables institutions to reexamine the objectives, policy goals, and decision-making procedures of the global health architecture. Shared health governance, in turn, provides standards for regulating global and domestic institutions and practices to create the conditions for realizing individuals’ health capabilities.

The third chapter presents the book’s new proposal for addressing the access to medicines problem. It suggests that by collecting and analyzing data on global health, people can come up with new ways to improve poor people’s access to essential drugs and technologies. It suggests utilizing information about medicines’ global health impact (organized by drug, disease, country, and company) to create incentives for positive change. One possibility is to give pharmaceutical companies with the most impactful drugs a Global Health Impact label to use on all their products. Highly rated companies will have an incentive to use the label to get a larger share of the market. Further, socially responsible investment companies could include Global Health Impact companies in their portfolios. Finally, having a Global Health Impact certification system for pharmaceutical companies would open the door to all kinds of fruitful social activism. One possibility is a Global Health Impact licensing campaign. Pharmaceutical companies rely, to a large extent, on university research and development. So, if universities allow only certified companies to benefit from their technology, companies will have an incentive to abide by Global Health Impact standards.

Looks at the range of innovations that have emerged in recent years to improve financing for global health objectives, and examines various approaches, including global levies like UNITAID and UNITLIFE; an array of market shaping initiatives like prizes and challenges and the GAVI Alliance’s advanced market commitments; a variety of innovations related to debt, including loan forgiveness and ‘debt swaps’ administered through the Global Fund, Pledge Guarantee for Health, the International Finance Facility for Immunization (IFFIm)’s vaccine bonds; and equity investments—impact investment vehicles like the Global Health Investment Fund—that blend philanthropic and commercial capital for drug research and development and other health interventions.

The sixth chapter suggests that examining the prospects for a Global Health Impact labeling and certification campaign might expand the domain of traditional philosophical inquiry in an important way. It presents a proposal for testing consumers’ willingness to make decisions based on a Global Health Impact label. The basic idea is to put a Global Health Impact label on a few over-the-counter products and to collect data on changes in consumers’ willingness to purchase these products compared to otherwise similar generic versions of the products from sales. The chapter explains how carrying out this test might provide an example of a new kind of experimental philosophy. Although most experimental philosophy has focused on individuals’ intuitions and is modeled on the psychological literature, there is a lot of empirical work in other disciplines, and many useful methods are available for answering important questions experimental philosophers might want to address.

The right to a safe and healthy work environment is a fundamental human right. Two organizations within the United Nations system are directly concerned with occupational health: the International Labor Organization (ILO and the World Health Organization (WHO). In order to achieve this, the ILO formulates international standards in the form of Conventions and Recommendations, dealing with occupational health and safety and other work-related issues and administers the legal framework for occupational health protection in international law. Each covenant and convention is designed to be universally applicable, flexible, viable (feasible) and adaptable as needed. The ILO also develops Codes of Practice in the form of detailed technical specifications that apply to various problems and industries that governments, employers and workers’ organizations can use to determine what should be done. Occupational health and safety standards may be written as guidance for policies, to protect workers from unnecessary risks, to protect workers in certain industries. The WHO investigates the scientific basis for controlling occupational health problems and supports educational programs. Its primary means of doing is the Global Strategy in Occupational Health for All, which is intended to strengthen national infrastructure and services in occupational health and the development of occupational health standards based on scientific risk assessment.

This chapter focuses on the global initiative—the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI)— which seeks to establish a Framework Convention on Global Health (FCGH). It outlines the JALI’s manifesto on global health justice and a FCGH; discusses how powerful vested interests are vigorously resisting the FCGH; and considers the role of transnational advocacy coalitions. Drawing on a conceptual framework in policy sciences literature—one which explains that policy change results from interactions between ‘interests’, ‘ideas’, and ‘institutions’—the chapter discusses how developments in each of these three streams may influence the strategies JALI and how the movements it fosters, supports, and allies itself can influence future inter-governmental negotiations on a Convention.

Global inequality impacts global health. The rich can, but the poor cannot, access many of the existing medicines they need. This paper considers the prospects for rating pharmaceutical companies' efforts to extend access on essential medicines to the poor. It argues that it is possible to design a good rating system – one that rewards highly rated companies for doing things that actually promote global health. It also suggests that practical work on promoting global health can yield interesting philosophical questions and conclusions by highlighting some of the normative choices that are important to address in developing a good rating system.

This chapter considers international perspectives in the area of health promotion. It begins with an overview of health promotion as a global enterprise, citing major developments such as the founding of the World Health Organization (WHO), the Alma Ata Declaration, and the introduction of the notion of the social determinants of health by Thomas McKeown. It then examines the Ottawa Charter for Health Promotion (1986) and the five health promotion areas that it identified for achieving better health: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services. The chapter goes on to discuss other international health promotion initiatives, including the Bangkok Charter for Health Promotion in a Globalized World (2005) and the Helsinki Global Conference on Health Promotion (2013). Finally, it analyses the role of the WHO in health promotion, along with the issues of health inequalities and health inequities.

This chapter introduces the Global-Health Impact Labels (GHILs), which are a form of accreditation awarded to corporations that have made significant impact on global health. Though the idea is not without its criticisms, it can at least be implemented in the medical tourism industry in order to alleviate brain drain concerns in developing countries.

This chapter argues that current theorizing about global health rests on opposing ontological worldviews about what global health should prioritize and that these presuppositions result in distinctively antagonistic normative demands about how we should calculate the distribution of global health. In order to understand these existing antagonisms, this chapter will explore three diverse normative arguments (the proximity/statist thesis, lifeboat ethics and the cosmopolitan approach) regarding why we might have global health responsibilities and to further examine their relationship to distributive principles for the alleviation of global health inequalities. It is through this process of comparative investigation that the philosophical attractiveness of a cosmopolitan approach to global health will be stressed.

Berkman worked with former comrades to counter the denialists who believed HIV did not cause AIDS. Through Barbara Zeller’s connections, he made contacts with radical epidemiologists at Columbia’s School of Public Health. He began involved in combating HIV/AIDS in global health with them, especially in South Africa, and began to formulate the need for global action through an organization he founded called Health GAP (Health Global Action Project). Various cancers kept recurring, however, while he fought to continue working, now on the faculty at Columbia.

This chapter focuses on the emergence and experiences of Merina and Betsileo Malagasy Lutheran doctors and administrators who act as cultural translators or “middle figures” to the two American NGOs (cf. Hunt 1999). Rooting this subject position in Malagasy cultural practices of ethnic and regional differentiation, the chapter compares the role of Merina and Betsileo Malagasy physicians in the American aid relationship to the deeper cultural history of Merina-Anglo Protestant alliances well-documented in Malagasy ethnography and history. It examines three cultural activities – narratives that depict Malagasy Christian doctors as keepers of the Christian quality of medical care, medical case studies, and Malagasy doctors’ visits to U.S. Christian global health conferences – through which Merina and Betsileo physicians rework and perform the category expectations of this aid subjectivity, which combines qualities of the medical doctor, humanitarian and foreign missionary. The sum of these parts is a view of aid subjectivities as dynamic cultural formations that emerge from a confluence of factors, compelled into action through the conditions of aid while being rooted in Malagasy cultural histories and worked upon and transformed by both Malagasy and Americans.

As Berkman battled a variety of cancers over the first years of 2000s, he also continued his global health work on HIV/AIDS. Whether it was a demonstration at the United Nations to demand global treatment or training programs for the Clinton Foundation in the Dominican Republic or courses for students at Columbia, he used his knowledge and skills around the world. He had become a global health “elder” whose ideas and support mattered to another generation. The cancers he had fought through stem cell operations were finally more than his body to fight and he died in June 2009.

At first glance, neuroethics and global mental health would seem to have relatively little in common; the former is often focused on the use or misuse of novel and specialized neurotechnologies in specialized or high-income settings, while the latter is often focused on the scaling up of existing treatments in primary care settings in low- and middle-income countries. On closer examination, however, they have significant overlapping concerns and approaches that may be mutually empowering. They both (1) take a naturalist and empirical approach to their questions of interest, (2) are concerned with both disease and with well-being, (3) embrace human rights and patient empowerment, and (4) hold a deep appreciation for human diversity. This chapter considers each of these areas and argues for the importance of conversation and collaboration between neuroethics and global mental health toward a truly international neuroethics.

The book opens with a case study of a woman who died specifically from “not AIDS.” The argument of the book is primarily that the collection of HIV interventions that aim to mitigate the effects of the disease among HIV-positive people (particularly those interventions focused on modifying disclosure practices, changing sexual behavior, and encouraging visibility) entrench and reinforce HIV’s exceptional status. In addition to providing treatment options for people who meet certain clinical criteria, HIV care and support programs define and shape the process of “becoming HIV-positive.” Learning how to become HIV-positive entails rehearsing disclosure narratives and keeping up “appearances” (in the many senses of the word), which in turn enable and facilitate subjective experiences of exceptionality and hierarchy among the HIV-positive.

Chapter 2 explains how ideas about Sierra Leone’s civil war and various accounting practice (techniques of enumeration and stories of suffering) are produced and circulated about the epidemic in Sierra Leone, and how these practices shape HIV-positive people’s claims about their exceptionality.