Can Resource-Poor Countries Bear any Obligations for Global Distributive Justice? A Reflection on the Distribution of Global health Opportunities

Abstract

Can resource-poor countries bear any stringent obligations in the pursuit of equity in the distribution of global health opportunities between individuals globally? Distributive justice is primarily about resource transfer from those who have more than enough to those who are suffering severe scarcity. In the particular case of distributive justice in global health, given that most health opportunities cost money and given that the idea of ‘resource-poor countries’ entails that such countries lack sufficient resources in general and in particular health resources, the question of this work may seem a rhetorical one, seeking “no” as an obvious answer. On the contrary, however, despite the reality of severe resource scarcity among poor countries, the main thesis defended in this work is that poor countries (and in fact all countries whose economic situations qualify them for a moral right to external economic assistance) ought to bear certain stringent obligations in the pursuit of global distributive justice in general. This obligation applies even in the specific case of the pursuit of justice in the global distribution of certain basic health opportunities among individuals globally. This work is based on a general claim that in efforts to ensure distributive justice it is not enough to look at what amounts of resources should flow from the global haves to the global have-nots. The work demonstrates that even though resource flow from the global rich to the global poor is a necessary condition for achieving distributive justice in the current global circumstances, there is evidence which suggests that this may not be a sufficient condition for the achievement of global distributive justice; or at least reducing the current global inequities. Bearing in mind that global injustice, in this case, means unjust distribution of global resources and opportunities rather than global inequality per se, this work suggests that potential beneficiaries of redistribution (governments and citizens of Low and Middle Income Countries) need to behave in ways which confirm that current inequalities in global distribution of life chances and all opportunities for survival and human well-being are unjust in a sense that the current global maldistribution of resources cannot be attributed to their (victims) moral fault. If the current global inequalities can be attributed to their moral fault, then they ought to bear morally binding obligations to their (LMIC governments) citizens and those whose resources are to be redistributed. Short of this proviso it will not be possible to achieve global distributive justice in the strict sense of the word. It is this proviso that leads to an enquiry into possible obligations of poor countries in ensuring global distributive justice. This reasoning about what it may necessarily take to achieve global distributive justice is motivated by an insight that ignoring the victims’ (LMICs) obligations may lead to further injustice especially if affluent countries are morally required (with potential enforcement) to transfer their resources to cover deficits in victim countries, which deficits arise out of the moral fault of those governments. The insight also extends to the possibility that current efforts might fail to achieve the desired global threshold distribution of material and social well-being for poor country citizens especially if their governments behave like economic ‘black holes.’ The first chapter of this work examines existing literature on global justice, particularly global distributive justice, ultimately focusing on justice in the distribution of global health opportunities. The analysis confirms the existence of morally binding and potentially enforceable obligations of all countries in ensuring justice in global resource distribution. Using the case of efforts towards fair distribution of global health opportunities, the analysis shows how failure to think about resource-poor country obligations makes it extremely difficult both in theory and practice to achieve global health equity. The second chapter asks and attempts to answer a critical question regarding why the efforts of mutually reinforcing discourses on ‘global justice’ and ‘human rights’ have not succeeded in achieving justice in the global distribution of health opportunities. The analysis of this question leads to a conclusion that the futility of countries’ obligations for global distributive justice, which are mainly framed as human rights obligations, is due to their constrained specificity and stringency which is inherent in current obligations. The analysis leads to a proposal that in order to eschew this futility or at least reduce it significantly, morally binding obligations of countries to contribute to global distributive justice should be specified in terms of how much resources should be contributed by poor countries on the one hand, and affluent countries on the other in order to cover a certain minimum level of health resource distribution to all individuals globally. The third chapter uses the case of Uganda to demonstrate the nature of reasoning about the practical and moral necessity of thinking about potential obligations of poor countries in ensuring global distributive justice in general. The major insight demonstrated in this chapter is that if global justice is to be achieved, then poor country governments should not be seen merely as victims of unethical global politics and economics but also as agents who can avoid and mitigate some external harms and who, therefore, bear morally binding obligations to their citizens and to those whose resources are to be redistributed. Chapter four makes use of the special case of efforts to ensure justice in the global distribution of health opportunities to propose and demonstrate a mechanism which can be used to achieve justice in global health resource distribution. This proposal is based on the conception of obligations of poor countries as a necessary complement to those (obligations) of affluent countries in the pursuit of justice in the global distribution of health opportunities. The proposal is also based on the claim that distributive justice requires proportionate allocation of burdens between all the actors involved in the process of redistribution towards a certain threshold of distribution. That is, justice in this case requires that there ought to be equitable burden-sharing between the beneficiaries of redistribution and those whose resources are to be redistributed. This chapter proposes that a certain minimum level of health opportunities for all individuals be specified in form of the minimum health expenditure per capita (for each country) and the cost of guaranteeing these minimum health opportunities should be covered entirely using pooled public resources contributed by both external actors (donor country governments) and domestic actors (poor country governments). This proposal demonstrates the ethical and practical importance of obligations of poor countries in ensuring global justice, particularly justice in ensuring equitable distribution of health opportunities globally.