1. Summerschool Health law and ethics Erasmus University Rotterdam, July 2009 Social responsibility and health Article 14: 1. The promotion of health and social development for their people is a central purpose of governments that all sectors of society share.

2. Social responsibility and health Article 14: 2. Taking into account that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition, progress in science and technology should advance: a.access to quality health care and essential medicines, especially for the health of women and children, because health is essential to life itself and must be considered to be a social and human good; b.access to adequate nutrition and water; c.improvement of living conditions and the environment; d.elimination of the marginalization and the exclusion of persons on the basis of any grounds; e.reduction of poverty and illiteracy

3. Social responsibility and health OUTLINE 1.Highest attainable standard of health as a fundamental human right 2.Health and the impact of social and overall living conditions 3.The state of health today – the social context of health 4.Duties and responsibilities 5.Health and contemporary challenges to social justice

4. Social responsibility and health 1. Highest attainable standard of health as a fundamental human right Universal Declaration of Human Rights, 1948: Article 25. (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

5. Social responsibility and health 1. Highest attainable standard of health as a fundamental human right Constitution of the World Health Organization, 1946: The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

6. Social responsibility and health 1. Highest attainable standard of health as a fundamental human right International Covenant on Economic, Social and Cultural Rights, 1966 Article 15 1. The States Parties to the present Covenant recognize the right of everyone: (b) To enjoy the benefits of scientific progress and its applications;

7. Social responsibility and health 1. Highest attainable standard of health as a fundamental human right International Covenant on Economic, Social and Cultural Rights, 1966 Article 12 1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

8. Social responsibility and health 2. Health and the impact of social and overall living conditions - Health care initiatives need to take into account the broad development context - Reduction of poverty - Stewardship of the environment - Assurance of human rights - Gender equity - Global security Health as - a means to other development goals - as an end in itself

9. Social responsibility and health 2. Health and the impact of social and overall living conditions - Ethical significance of public and population health initiatives synergistic relationship between health and other aspects of development - poverty undermines a range of human capabilities including health - need to reduces the burden of excess mortality and morbidity suffered by poor populations - sensitivity of health to the social environment and the ‘social determinants of health - inequalities between men and women, regions, ethnic groups, rural and urban areas

10. Among ca. 6800 million human beings, about 800 million are undernourished (UNDP 2007, p. 90), 1 bn now (FAO) 2000 million lack access to essential drugs (www.fic.nih.gov/about/plan/exec_summary.htm), 1085 million lack access to safe drinking water (UNDP 2007, p. 254), 1000 million lack adequate shelter (UNDP 1998, p. 49), 2000 million have no electricity (UNDP 2007, p. 305), 2600 million lack adequate sanitation (UNDP 2007, p. 254), 774 million adults are illiterate (www.uis.unesco.org), 211 million children (aged 5 to 17) do wage work outside their household — often under slavery-like and hazardous conditions: as soldiers, prostitutes or domestic servants, or in agriculture, construction, textile or carpet production (ILO: The End of Child Labour, Within Reach, 2006, pp. 9, 11, 17-18). Social responsibility and health 3. The state of health today – the social context of health

11. 11 Social responsibility and health 3. The state of health today – the social context of health Poverty-related causes of human death - 18 million per year (out of 57) - or 50 000 per day Respiratory infections, mainly pneumonia 3 963 000 HIV/AIDS 2 777 000 Perinatal conditions 2 462 000 Diarrhea 1 798 000 Tuberculosis 1 566 000 Malaria 1 272 000 Childhood diseases (mainly measles) 1 124 000 Malnutrition 485 000 WHO: World Health Report 2004 Cheaply preventable through safe drinking water, better sanitation, more adequate nutrition, rehydration packs, vaccines or other medicines

12. 55 30 20 15 9 7.5 5.5 300 050 100 150 200 250 300 Worldwide poverty deaths 1990-2008 World War Two 1939-1945 Mao’s Great Leap Forward 1959-62 Stalin’s Repression 1924-53 World War One 1914-1918 Russian Civil War 1917-22 Congo Free State 1886-1908 Korea and Vietnam 1951-54,1965-74 Millions of deaths

13. Least developed countries Less developed countries High developed countries GNP per capita (US $)1,5245, 43026,395 Infant mortality94607 Life expectancy (yr)516476 Maternal mortality (per 100.000 births) 9502028 Fertility rate5.12.91.6 Births per 1000 women 15- 19 yrs 1196126 Female adult illiteracy (%)62180 Differences in the world (Human Development Report, 2005. New York)

14. Shares of Global Wealth 2000; poorest versus richest households Up to 60 th Percentile ($645 average) 80 th -90 th Percentile ($17,924 average) 95 th -99 th Percentile ($156,326 average) Top One Percent ($812,693 average) 60th-80th Percentile ($4,277 average) 90th-95th Percentile ($59,068 average) 1.9%

15. Global Wealth Inequality At current exchange rates, the poorest half of the world’s population, some 3,400 million people, have about 1 percent of global wealth ― as against 3 percent owned by the world’s 1125 billionaires.

16. Global Income Inequality At current exchange rates, the poorest half of world population, some 3,400 million people, have less than 3% of world income ― as against 6% received by the most affluent one percent of US households consisting of 3 million people.

17. Shares of Global Income 2005; poorest households versus richest countries 79% 20% 1% The poorest households (40% of humankind) The richest countries (16% of humankind Others (44% of humankind)

18. Social responsibility and health 4. Duties and responsibilities 1. The state of being responsible, accountable, or answerable.responsibleaccountableanswerable Responsibility is a heavy burden. 2. A duty, obligation or liability for which someone is held accountable.dutyobligationliability Why didn't you clean the house? That was your responsibility! The responsibility of the great states is to serve and not to dominate the world (Harry S. Truman) Responsibility

19. Social responsibility and health 4. Duties and responsibilities Responsibility Insofar as health status is not affected by human action, no one is responsible for them Insofar as deterioration of health status is avoidable through active intervention Insofar as deterioration of health status is caused or aggravated through active intervention Positive responsibility Negative responsibility acting refrain from acting

20. Social responsibility and health 4. Duties and responsibilities Duties - Positive duties we need to provide assistance, be active in order to contribute to the improvement of global health, e.g. through helping to establish social arrangements that will alleviate health deterioration - Negative duties we need to refrain for interventions, we must not contribute to designing or imposing social arrangements that contribute to deterioration of global health

21. Social responsibility and health 4. Duties and responsibilities Types of duties a.Imperfect duties -Duties beyond the constraints and obligations determined by law -Duties of beneficence: morally binding for individuals but they cannot be demanded or imposed by others -Moral duties, irrespective of some kind of (human) rights -Example: duties of good citizenship; solidarity b.Perfect duties -Duties determined by law -Duties of justice -Public; they can be demanded by the State -Correlative to the rights of others -Example: paying taxes

22. Social responsibility and health 4. Duties and responsibilities ‘social responsibility’ - Notion of responsibility extended from individuals to groups, communities, institutions and corporations - Groups, communities, institutions and corporations have moral duties that go beyond what is legally required - Social responsibility is connected to the moral vocabulary of imperfect duties: they have duties that cannot be imposed by others or are legally required. - Social responsibility can be negative or positive: can go together with negative duties (refrain from acting) and positive duties (acting is required)

23. Social responsibility and health 4. Duties and responsibilities ‘social responsibility’ at different levels The degree of responsibility increases as one’s amount of control over a given situation rises - responsibilities of governments - primary duty is to uphold and protect the rights of its citizens - to provide the environment that could maximize the contributions of other sectors - responsibilities of the health sector and the medical profession - responsibility of the private sector and industry

24. Social responsibility and health 4. Duties and responsibilities responsibility of the private sector and industry An example: United Nations Global Compact The UN Global Compact is a strategic policy initiative for businesses that are committed to aligning their operations and strategies with ten universally accepted principles in the areas of human rights, labour, environment and anti-corruption. By doing so, business, as a primary agent driving globalization, can help ensure that markets, commerce, technology and finance advance in ways that benefit economies and societies everywhere.ten universally accepted principleshuman rightslabour environmentanti-corruption From the website (http://www.unglobalcompact.org):http://www.unglobalcompact.org over 4700 corporate participants and stakeholders from over 130 countries Corporate social responsibility

25. Social responsibility and health 5. Health and contemporary challenges to social justice a.Access to essential drugs and health services More than 33% of the global population has no access to essential drugs The development of drugs for tropical diseases has progressed very little Even when drugs are available, they are often inaccessible for those who need them most b.Poverty and the HIV/AIDS pandemic HIV/AIDS spreads more rapidly in poor countries and among poor people

26. Social responsibility and health 5. Health and contemporary challenges to social justice c.Standard of care international health research Migration of research to developing countries without addressing the needs of those countries Need to develop local expertise and address local problems Brain drain d.The protection of vulnerable populations e.Research prioritization Global health research funding: only 10% of research resources address the needs of the developing world Research projects carried out in poor countries should be relevant to their needs; participants should be regarded as stakeholders in the research projects

27. Social responsibility and health 5. Health and contemporary challenges to social justice f.Providing health care services across national boundaries alarming migration of doctors and other health care workers g.Organ transplantation and medical tourism ongoing practice of transplanting organs from the poor to the rich medical tourism industry: disguising the injustices associated with transnational exploitation

28. Social responsibility and health - a new principle with far reaching implications for the agenda of global bioethics - many issues and implications need further analysis and research - there is a wealth of data concerning problems and issues to be addressed but a lack of illuminating examples, successful cases and best practices showing effective policies and good solutions Conclusion