Redressing the Unconscionable Health Gap: A Global Plan for Justice

Consider two children—one born in sub-Saharan Africa and the other in the United States. The African child is twenty-five times more likely to die in the first five years of life; if she lives to child-bearing age, she is a two hundred times more likely to die in labor; and overall, she will die thirty years earlier than the American child. The international community is deeply resistant to taking bold remedial action—more concerned with their geostrategic interests than the health of the poor. The scale of foreign aid is both insufficient and unsustainable and fails to address the key determinants of health. As a result, the world’s distribution of the “good” of human health remains fundamentally unfair, causing enormous physical and mental suffering by those who experience the compounding disadvantages of poverty and ill health. If the health gap is unfair and unacceptable, then how can the international community be galvanized to make a genuine difference? In this article, I propose an international call to action through the adoption of a Global Plan for Justice (GPJ)—a voluntary compact among states and their partners in business, philanthropy, and civil society to redress health inequalities. The GPJ would be a form of “soft” norm setting, rather than a legally binding treaty, achieved with the passage of a World Health Assembly resolution. Under the GPJ, states would devote resources to a Global Health Fund based on their ability to pay—for example, 0.25% of Gross National Income (GNI) per annum—in addition to maintaining current development assistance devoted to programs and activities of their choice. Global Health Fund resources would be allocated based on the health needs of developing countries measured by poverty, morbidity, and premature mortality. The core missions of the Global Plan for Justice would be to (1) ensure the fair allocation of essential vaccines and medicines, with particular attention to low- and middle-income countries in a public health emergency; (2) meet basic survival needs, creating the conditions in which people can be healthy; and (3) help countries that will suffer most to adapt to the health impacts of climate change. For an explanation of how the GPJ fits into other innovative Global Health Governance strategies, see http://www.law.georgetown.edu/oneillinstitute/documents/2010-07_Global_Health_Justice.pdf and http://www.acslaw.org/node/16479 (explaining the progression from a Joint Learning Initiative for National and Global Responsibilities for Health, to a Global Plan for Justice, through to a Framework Convention on Global Health). See also, Lawrence O. Gostin, Meeting Basic Survival Needs of the World’s Least Healthy People: Toward a Framework Convention on Global Health, 96 GEO. L.J. 331 (2008), http://ssrn.com/abstract=1014082, http://scholarship.law.georgetown.edu/ois_papers/1/. For an examination of essential services to be provided by the Global Plan for Justice, see Lawrence O. Gostin, The Unconscionable Health Gap: A Global Plan For Justice, 375 THE LANCET 1504 (May 1, 2010), available at http://www.thelancet.com/journals/lancet/issue/vol375no9725/PIIS0140-6736%2810%29X6124-4