Distributing Who Gets What and Why: Four Normative Approaches to Global Health
| Published date | 01 September 2012 |
| DOI | http://doi.org/10.1111/j.1758-5899.2012.00180.x |
| Date | 01 September 2012 |
| Author | Garrett Wallace Brown |
Distributing Who Gets What and
Why: Four Normative Approaches to
Global Health
Garrett Wallace Brown
Department of Politics, University of Sheffield
Abstract
When surveying policy documents on global health one is often struck by a general lack of theorizing about why we
have moral duties to promote equitable global health initiatives and in regards to what prioritized values should
represent the satisfaction of these moral duties. Although there is general agreement that current inequalities in
global health provision exist, and agreement that some form of response is necessary, there is little consensus about
what should be done to rectify this situation. The purpose of this article is to explore four normative arguments about
why we might have global health responsibilities and to examine their relationship with distributive principles for the
alleviation of global health inequalities. Through this examination it will be argued that current theorizing about
global health rests on opposing ontological perspectives about what global health should prioritize and that these
presuppositions result in distinctively antagonistic normative demands about how we should distribute, who gets
what and why.
Policy Implications
•Creating a more equitable distribution of global health requires policy makers to seriously rethink the key presup-
positions, assumption and biases that underpin and perpetuate the inequalities involved with current global health
policy.
•In rethinking global health policy – and if we believe reaching some level of health equity to be a morally impor-
tant endeavor – then greater commitments to the distributive and deliberative properties of cosmopolitan devel-
opmental partnerships will be required.
•To this end, global health equity will require cosmopolitan commitments to individual health beyond state and civ-
ilizational boundaries, a renewed focus on the social determinants of health, key reforms to unjust global economic
practices, and the reformation of global decision making toward more inclusive and deliberative governance forma-
tions.
When surveying policy papers related to global health
one is often struck by a general lack of theorizing about
why we have moral duties to promote equitable global
health initiatives and in regards to what prioritized val-
ues should represent the satisfaction of these moral
duties. Although there is agreement that current inequal-
ities in global health provision exist, and agreement that
some form of response is necessary, there is little con-
sensus about what should be done to rectify these ineq-
uities (Daniels, 2008; Ooms and Hammonds, 2010). As a
result, there continues to be general ambiguity about
what normative arguments should underwrite global
public health policy, with many current appeals sup-
ported by generalized practical claims to health as a
security threat or on unspecified appeals to humane
moral responsibilities (Terry, 2002). In order to provide
some theoretical reflection, the purpose of this article is
to explore four normative arguments about why we
might have global health responsibilities and to examine
their relationship with distributive principles for the alle-
viation of global health inequalities. Through this exami-
nation it will be argued that much of the current
theorizing about global health rests on opposing onto-
logical worldviews about what global health should
prioritize and that these presuppositions result in distinc-
tively antagonistic normative demands about how
we ought to distribute ‘who gets what and why.’ How-
ever, there is another motivation for examining these
Global Policy Volume 3 . Issue 3 . September 2012
ª2012 London School of Economics and Political Science and John Wiley & Sons Ltd. Global Policy (2012) 3:3 doi: 10.1111/j.1758-5899.2012.00180.x
Research Article
292
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