The Global Health Crisis: Ethical Responsibilities by Thana Cristina de Campos

The Global Health Crisis: Ethical Responsibilities, Thana Cristina de Campos (Cambridge: Cambridge University Press, 2017), 299 pp., $110 cloth.

This new work from Thana Cristina de Campos focuses on identifying the moral responsibilities of global stakeholders in the field of health, with particular emphasis on so-called neglected diseases, including malaria and tuberculosis, which the author defines as diseases that mainly afflict poorer populations. The term “neglected” indicates that there is a lack of research and development of new drugs to address these diseases and a lack of available and affordable medicines to treat those who are affected. Among other issues, this raises the question of whether the pharmaceutical industry has a responsibility to ensure that such drugs are affordable to the global poor.

The book’s emphasis on the responsibilities of nonstate actors in the global health crisis, particularly the pharmaceutical industry, is one of the most compelling and useful parts of its overall analysis. Such a moral framework is desperately needed, as it could help address an important regulatory gap in international law, namely, the fact that pharmaceutical companies and other relevant actors are not bound by international law, given that they are not parties to the treaties concerned. It is a sad reality that international law is still primarily state-centric, and that it fails to tackle the responsibilities of nonstate actors directly, despite the dramatic impact that their activities often have on our health and wellbeing. Thus, human rights advocates and international lawyers should take note of this study as they seek to build a framework for tackling the human rights responsibilities of multinational corporations. By reaching beyond the legal borders of our own field and by looking into what ethics has to offer, we may find additional important normative arguments that can strengthen our legal position.

So what does de Campos’s moral framework look like? The overall analysis, which is clearly and systematically presented, is grounded on the general premise that all global stakeholders should respect the right to health. De Campos clearly moves away from the state-centric responsibility to remedy global poverty, as advanced by the “conventionalist” David Miller, finding this approach insufficient. Instead, she thinks more along the lines of the “revisionist” scholar Thomas Pogge, who argues that state actors are not the exclusive subjects of international law, nor the exclusive bearers of human rights responsibilities.

Nonstate actors, according to Pogge, play a crucial role in the global economic order and they thus bear responsibilities for global problems. But de Campos adds another layer to Pogge’s analysis, partly based on the work of Thomas Aquinas, and concludes that both state and nonstate actors are institutionally connected to the global poor and ill (p. 147). As a result, they all carry certain duties of justice (as opposed to weaker duties of benevolence) to remedy the global health crisis. De Campos proposes a set of scenarios in what she calls “Global Commutative Justice,” whose complementary principles of subsidiarity and solidarity regulate the responsibilities among global stakeholders. The implication of this framing is a greater responsibility for nonstate actors, which from a human rights perspective is very worthwhile.

Chapter four makes an important point regarding the medical patent system. Here the author argues on the basis of three different theories of private property (from Aquinas, John Locke, and Robert Nozick, respectively) that certain responsibilities of justice apply to pharmaceutical companies specifically as the owners of a particular type of property, namely, medical patents. De Campos concludes that the industry has a responsibility to disclose some of its medical knowledge, given that this information is vital in addressing the global health crisis. This responsibility is an important point for international lawyers to incorporate into their work, as arguably this duty could be part of the responsibility of multinational corporations to respect human rights (and the right to health specifically), as stipulated in the UN Guiding Principles.

Although it has several merits, the book has two primary shortcomings. First, de Campos asserts that we have a global health crisis because of the so-called neglected diseases. However, presenting neglected diseases as the most pressing global health problem overlooks the current reality that, according to the World Health Organization, noncommunicable (chronic) diseases—including cancer, diabetes, and respiratory and coronary diseases—are collectively responsible for almost 70 percent of all deaths worldwide. Further, these chronic diseases are no longer only a Western phenomenon, as they contribute to premature deaths in all parts of the world—low and middle income countries in particular. In addition, the "neglected diseases" are not truly neglected, as considerable treatment options have been developed. The problem is that such treatments and drugs are too costly for many countries to make use of, and the health infrastructure in low and middle income countries is often not equipped to address the sophisticated treatment these chronic conditions tend to require.

We are thus facing a much broader global health crisis, where large parts of the world’s population are at risk of dying of “Western” diseases without access to proper treatment and care. A host of risk factors sits at the root of these diseases, including tobacco and alcohol use, poor diets, and a lack of physical exercise, as well as environmental pollution and climate change. Hence, while the pharmaceutical industry is certainly a key actor in the global health crisis, we should not overlook the roles and responsibilities of other nonstate actors—notably the cigarette and fast food industries.

Second, on several occasions the author emphasizes the importance of the protection of the right to health of the global poor. However, this study does not systematically integrate human rights law with its ethical analysis. This is regrettable, as a more integrated interdisciplinary approach could have stimulated cross-fertilization between the moral and the legal human rights debate, leading to concrete suggestions for improving existing human rights tools, and filling some gaps in the practice. There are several implicit references to human rights law in the study, which could have been illustrated with references to relevant human rights standards. To start with, the responsibility of all stakeholders to respect human rights is also reflected in the Universal Declaration of Human Rights, which in its preamble refers to the human rights responsibilities of “every individual and every organ of society.”

There is indeed a crisis in the availability and affordability of medicines worldwide. As de Campos correctly points out, two billion people globally lack access to affordable medicines. A study on the ethical and philosophical perspectives of the global health crisis is therefore important and necessary, and The Global Health Crisis is a welcome contribution to the discussion. Human rights advocates and international lawyers—who often focus narrowly on international standards as legal obligations and thus overlook the underlying moral rationale for such norms—would do well to grapple with it.

—Brigit Toebes

Brigit Toebes, associate professor and Rosalind Franklin Fellow, holds the Chair in International Health Law at the University of Groningen Faculty of Law.