Cuba currently has more than 38,000 health workers providing emergency relief, long-term community-based care and medical education to some of the most vulnerable communities in the world. This current outreach to 76 countries positions Cuba as a leader in global health outreach. This has been well documented and praised by many scholars and policy makers alike. While many acknowledge the importance and impact of the Cuba’s global effort, there is very little understanding as to why Cuba makes such a large (...) global health commitment in the first place. I argue that solidarity is in fact a mixture of national pride, self-interest and humanistic outreach. Ultimately, it is a calculated effort to overcome current structures of inequity and exploitation on a global scale by expanding new opportunities for health professionals dedicated to providing care in marginalized communities. (shrink)

Abstract:This article examines the relationship between philosophy and culture in global bioethics. First, it studies what is meant by the term “global” in global bioethics. Second, the author introduces four different types, or recognizable trends, in philosophical inquiry in bioethics today. The main argument is that, in order to make better sense of the complexity of the ethical questions and challenges we face today across the globe, we need to embrace the universal nature of self-critical and analytical philosophical analysis and (...) argumentation, rather than using seemingly philosophical approaches to give unjustified normative emphasis on different cultural approaches to bioethics. (shrink)

This essay describes and critically evaluates a co-operative educational program to train Ugandan health care workers in bioethics. It describes one bottom-up effort, a week-long intensive workshop in bioethics provided by the authors to health care professionals in a developing country—Uganda. We will describe the background and circumstances that led to the organization of the workshop, and review its planning, design, curriculum, and outcome. We will focus especially on measures taken to make the workshop relevant for the audience of Ugandan (...) professionals, and describe lessons learned after two presentations of the workshop. Finally, we will discuss the strengths and weaknesses of such a format, and its potential value in raising bioethical expertise in developing countries. (shrink)

Corresponding Author, Health Policy & Ethics Fellow, Chronic Disease Prevention & Control Research Center, Department of Medicine, Baylor College of Medicine, 1709 Dryden, Suite 1025, Houston, TX 77030, USA. Tel.: 713.798.5482; Fax: 713 798 3990; Email: danielg{at}bcm.edu ' + u + '@' + d + ' '//--> . Abstract This article defends a broad model of public health, one that specifically addresses the social epidemiologic research suggesting that social conditions are primary determinants of health. The article proceeds by critiquing one (...) of the strongest arguments in favor of a narrow model, advanced by Mark Rothstein. The critique sets up the argument that a model of public health that does not address what actually causes health and disease is unlikely to improve public health. Assessing the substantial evidence regarding the social determinants of health, the article engages the policy paradox that precludes utopian prescriptions but demands more than mere expedience. CiteULike Connotea Del.icio.us What's this? (shrink)

Randomized experiments, as developed by Esther Duflo and Abhijit Banerjee at the Abdul Latif Jameel Poverty Action Lab, offer a novel, evidence-based approach to fighting poverty. This approach is original, in that it imports the methodology of clinical trials for application in development economics. This paper examines the analogy between J-PAL’s field experiments in development economics and randomized controlled trials in medicine. RCTs and randomized field experiments are commonly treated as identical, but such treatment neglects some of the major distinguishing (...) features that make each experiment specifically apt for use in its respective field. The central claim of this paper is that the analogy between medicine and development economics is incomplete because the central dimensions of RCTs are not simply different but altogether lacking in J-PAL’s approach. This weakens both the political and the theoretical power of such experiments in development economics. (shrink)

Thomas Alured Faunce, College of Law, Fellows Road, Acton, Canberra ACT 0200, Australian National University, Fax: 61 2 61253971, Email: Thomas.Faunce{at}anu.edu.au ' + u + '@' + d + ' '//-->This paper sets out to analyse three different academic proposals for addressing the needs of the poor in relation to new, rather than ‘essential’ medicines. It focuses particularly on research and development prize funds, a health impact fund system and a multilateral treaty on health technology cost-effectiveness evaluation and competitive tender. (...) It compares the extent to which each responds to the ‘market fundamentalist’ philosophy and begins to analyse their respective strengths and weaknesses. CiteULike Connotea Del.icio.us What's this? (shrink)

This article critically examines current responses to multi-drug resistant tuberculosis and argues that bioethics needs to be willing to engage in a more radical critique of the problem than is currently offered. In particular, we need to focus not simply on market-driven models of innovation and anti-microbial solutions to emergent and re-emergent infections such as TB. The global community also needs to address poverty and the structural factors that entrench inequalities—thus moving beyond the orthodox medical/public health frame of reference.

The general scholarship on armed conflict in Manipur, India, ignores the experiences of women as agents. Feminist scholarship counters this tendency, revealing women's everyday responses to the violence that constrains them. However, this scholarship often fails to be intersectional, and it lauds every instance of women's agency without evaluating it in terms of its ability to build peace. Employing Kimberlé Crenshaw's underused distinction between structural and political intersectionality and Saba Mahmood's concept of agency, I analyze my field research conducted with (...) women's peacebuilding groups in Manipur in 2014 and 2015. Using structural intersectionality, I first describe the qualitatively different experiences of women peacebuilders living at different social locations. Using political intersectionality as a normative tool, I then show that ethnic and religious hierarchies often disrupt women's attempts to build peace. Interethnic peacebuilding groups that rely on gender-based solidarity tend to privilege the experiences of the women coming from the majority ethnic group. Other peacebuilding groups, bound by ethnicity, often distrust and resent women who come from different ethnic enclaves. I argue that women's peacebuilding agency must aim at an inclusive justpeace if it is to succeed. We should evaluate agency, rather than glorifying all instances of women's responses to violence. (shrink)

Journal of Social Philosophy, EarlyView.

Some are born to sweet delight,Some are born to endless night.William Blake - Auguries of InnocenceIt goes without saying that severe poverty is a human tragedy. The problem of poverty stemming from inequality has however only recently become one of the most fundamental questions in international ethics. The publication in 1972 of Peter Singer's important article, “Famine, Affluence and Morality” certainly marks an important date in the literature. Even those who don't agree with Singer's utilitarian approach will recognize that he (...) was among the first to articulate the problem of poverty on an international scale in philosophical terms. Since then, a greater number of philosophers have examined the problem of world poverty. Some of their work has been extremely influential. (shrink)

This article aims to demonstrate how the impact of humanitarian crises on health outcomes is related to social justice issues, even when these crises are brought upon by natural disasters. Pre-existing inequalities between individuals and social groups within a community affect in important and complex ways the health disparities which result from natural disasters. Drawing on the thought-provoking work of Paul Farmer, my main hypothesis is that socio-political factors prior to natural disasters determine ‘structured health risks’ that humanitarian crises will (...) necessarily exacerbate. To adequately respond to these structured health risks, medical humanitarianism cannot abide by an apolitical approach which mainly focuses on emergency relief. A more comprehensive analysis of the socio-political aspects of the health impact of humanitarian crises indicates that a more comprehensive approach to medical humanitarianism is necessary. This has three implications. First, a coherent account of medical humanitarianism needs to assess the international dimension of structural injustice that leads to structured health disparities. Second, this comprehensive approach to medical humanitarianism supports the ‘denaturalization of natural disasters’ argument. Third, medical humanitarianism should be organized around a broader and more complex approach of overlapping sequences which bridge emergency relief, reconstruction and development through a better aligned, orchestrated and coherent international effort. (shrink)

Ubuntu has been described as an African moral philosophy that finds actions grounded on good will to be right if they promote shared identity. I contend that freedom of expression is consistent with ubuntu. Freedom of expression enables people to be the most they can be, enabling the establishment of communities in which people can live together harmoniously. With reference to the violent South African society, the study examines broadcast media violence that may harm children to draw new insights concerning (...) the moral philosophy of ubuntu, media practice, and media literacy. (shrink)

In a previous issue of Zygon (Carvalho 2007), I explored the role of scientists—especially those engaging the science-religion dialogue—within the arena of global equity health, world poverty, and human rights. I contended that experimental biologists, who might have reduced agency because of their professional workload or lack of individual resources, can still unite into collective forces with other scientists as well as human rights organizations, medical doctors, and political and civic leaders to foster progressive change in our world. In this (...) article, I present some recent findings from research on three emerging viruses—HIV, dengue, and rotavirus—to explore the factors that lead to the geographical expansion of these viruses and the increase in frequency of the infectious diseases they cause. I show how these viruses are generating problems for geopolitical stability, human rights, and equity health care for developing nations that are already experiencing a growing poverty crisis. I suggest some avenues of future research for the scientific community for the movement toward resolution of these problems and indicate where the science-religion field can be of additional aid. (shrink)

Abstract.In a previous issue of Zygon (Carvalho 2007), I explored the role of scientists—especially those engaging the science‐religion dialogue—within the arena of global equity health, world poverty, and human rights. I contended that experimental biologists, who might have reduced agency because of their professional workload or lack of individual resources, can still unite into collective forces with other scientists as well as human rights organizations, medical doctors, and political and civic leaders to foster progressive change in our world. In this (...) article, I present some recent findings from research on three emerging viruses—HIV, dengue, and rotavirus—to explore the factors that lead to the geographical expansion of these viruses and the increase in frequency of the infectious diseases they cause. I show how these viruses are generating problems for geopolitical stability, human rights, and equity health care for developing nations that are already experiencing a growing poverty crisis. I suggest some avenues of future research for the scientific community for the movement toward resolution of these problems and indicate where the science‐religion field can be of additional aid. (shrink)

The substantive center of Christian ethics is Jesus’s ministry of the kingdom or reign of God, and its preferential inclusion of the poor, the outcast, and the sinner. What defines a gospel-based bioethics is a hopeful, practical commitment to improve the health of those who are most vulnerable to illness and early death because they lack basic needs. This commitment is distinctive of Christian bioethics, if not “unique” in the sense that no other bioethical approaches or traditions share it. To (...) succeed in reducing disparities in access to health care requires cooperative social action with members of multiple moral and political communities, meaning that there is no strict boundary between secular and Christian bioethics at the practical, political level, the level of applied Christian social ethics. (shrink)

In 2012 the Spanish government implemented the Royal Decree Law 16/2012 by which undocumented migrants are denied free access to the Spanish healthcare system. In the midst of unemployment, poverty and cuts in social protection, undocumented migrant women are facing multidimensional exclusions whereby austerity measures are having different consequences for women, especially for those who bear the greater brunt of caring roles in the form of mothering. Drawing upon qualitative research in the form of semi-structured interviews in Madrid, this article (...) examines the structural vulnerabilities of undocumented migrant mothers and analyses the gendered processes that provoke them. At a time in which the borders of Europe are reinforced and internal political and economic tensions question this fortress, migrants become shock absorbers for national anxieties. The article argues that the Royal Decree Law, following neoliberal discourses of citizenship and social rights and saturated by patriarchal normative understandings of women’s place in society and care, turns undocumented migrant mothers into disposable and invisible reproductive bodies deprived of rights. (shrink)

Although suffering in Schopenhauer’s works may be explained by how the will to life is objectified in the world, a more precise inquiry leads us to elucidate the significance of this experience in his writings. This article claims in the first place that suffering in this author’s works is triggered by multiple sources and takes various forms. In fact, and this is the article’s second claim, these sources coincide with some later scholars’ characterizations of modern suffering. The main aim is (...) to show the value of Schopenhauer’s works in understanding modern malaise. This article is divided into 4 parts: in the first part, some considerations about suffering and modernity are indicated; in the second part, the place of suffering in Schopenhauer’s works is explored; in the third part, some of suffering’s sources are analysed; finally, a number of dimensions that may be of great value in better understanding modern malaise are noted. (shrink)

The essays in this issue of JMP are devoted to critical engagement of my book, The Anticipatory Corpse. The essays, for the most part, accept the main thrust of my critique of medicine. The main thrust of the criticism is whether the scope of the critique is too totalizing, and whether the proposed remedy is sufficient. I greatly appreciate these interventions because they allow me this occasion to respond and clarify, and to even further extend the argument of my book. (...) In this response essay, I maintain that the regnant social imaginary of medicine is the regnant social imaginary of our time. It is grounded in a specific ontotheology: where ontology is a power ontology; where material is malleable to the open-ended organization of power and dependent only on working out the efficient mechanisms of its enactment; where ethically it is oriented only to the immanent telos of utility maximization in the short run, and ultimately to some posthuman future in the long run. This ontotheology originates in the anticipatory corpse and is ordered toward some god-like posthuman being. The entire ontotheology finds enactment through the political economy of neoliberalism. This social imaginary constantly works to insulate itself from other social imaginaries through the use of its institutional power, through marginalization, circumscription, or absorption. The modern social imaginary of neoliberal societies marginalizes and politically isolates other social imaginaries, or transforms them into something acceptable to the neoliberal imaginary. Yet, these other social imaginaries could influence the larger social imaginary in novel ways, sometimes through withdrawal and sometimes through challenges. These other practices—again, usually practices ordered according to different ontological and teleological purposes—might serve as a source of renewal and transformation, but only if the practitioners of these other social imaginaries understand the ontotheological powers that they are up against. (shrink)

In the first part of this article we survey the concept of human rights from a philosophical perspective and especially in relation to the “right to healthcare”. It is argued that regardless of meta-ethical debates on the nature of rights, the ethos and language of moral deliberation associated with human rights is indispensable to any ethics that places the victim and the sufferer in its centre. In the second part we discuss the rise of the “right to privacy”, particularly in (...) the USA, as an attempt to make the element of personal free will dominate over the element of basic human interest within the structure of rights and when different rights seem to conflict. We conclude by discussing the relationship of human rights with moral values beyond the realm of rights, mainly human dignity, free will, human rationality and response to basic human needs. (shrink)

Universal access to antiretroviral treatment (ART) in Chad was officially declared in December 2006. This presidential initiative was and is still funded 100% by the country’s budget and external donors’ financial support. Many factors have triggered the spread of AIDS. Some of these factors include the existence of norms and beliefs that create or increase exposure, the low-level education that precludes access to health information, social unrest, and population migration to areas of high economic opportunities and gender-based discrimination. Social forces (...) that influence the distribution of dimensions of well-being and shape risks for infection also determine the persistence of access barriers to ART. The universal access policy is quite revolutionary but should be informed by the systemic barriers to access so as to promote equity. It is not enough to distribute ARVs and provide health services when health systems are poorly organized and managed. Comprehensive access to ART raises many organizational, ethical and policy problems that need to be solved to achieve equity in access. This paper argues that the persistence of access barriers is due to weak health systems and a poor public health leadership. AIDS has challenged health systems in a manner that is essentially different from other health problems. (shrink)

Good nutrition plays an important role in the optimal growth, development, health and well-being of individuals in all stages of life. Healthy eating can reduce the risk of chronic diseases, such as heart disease, stroke, diabetes and some types of cancer. However, the capitalist mindset that shapes the food environment has led to the commoditization of food. Food is not just a marketable commodity like any other commodity. Food is different from other commodities on the market in that it is (...) explicitly and intrinsically linked to our human existence. While possessing another commodity allows for social benefits, food ensures survival. Millions of people in United States of America are either malnourished or food insecure. The purpose of this paper is to present a critique of the current food system using four meanings of the common good--as a framework, rhetorical device, ethical concept and practical tool for social justice. The first section of this paper provides a general overview of the notion of the common good. The second section outlines how each of the four meanings of the common good helps us understand public practices, social policies and market values that shape the distal causal factors of nutritious food inaccessibility. We then outline policy and empowerment initiatives for nutritious food access. (shrink)

Given that mitigating climate change is a large-scale global issue, what obligations do individuals have to lower their personal carbon emissions? I survey recent suggestions by Walter Sinnott-Armstrong and Dale Jamieson and offer models for thinking about their respective approaches. I then present a third model based on the notion of structural violence. While the three models are not mutually incompatible, each one suggests a different focus for mitigating climate change. In the end, I agree with Sinnott-Armstrong that people have (...) limited moral obligations to directly lower personal emissions, but I offer different reasons for this conclusion, namely that the structural arrangements of our lives place a limit on how much individuals can restrict their own emissions. Thus, individuals should focus their efforts on changing the systems instead (e.g., the design of cities, laws and regulation, etc.), which will lead to lower emissions on a larger scale. (shrink)

This chapter concerns the normativity of the concepts of paternalism and libertarian paternalism. The first concept is central in evaluating public health policy, but its meaning is controversial. The second concept is equally controversial and has received much attention recently. It may or may not shape the future evaluation of public health policy. In order to facilitate honest and fruitful debate, I consider three approaches to these concepts, in terms of their normativity. Concepts, I claim, may be considered nonnormative, normatively (...) charged, or normative in that they involve more complex relationships between values or duties. While the last approach is often best, other approaches may be appropriate depending on the context and purpose of discussion. The chapter’s conceptual investigation is illustrated by application to two public health policies: a tax on the consumption of fat and the encouragement of health-promoting food displays in restaurants and supermarkets. (shrink)

In our study of U.S. counterterrorism programs, we found that anthropology needs a mode of analysis that considers security as a form distinct from insecurity, in order to capture the very heterogeneity of security objects, logics and forms of action. This article first presents a genealogy for the anthropology of security, and identifies four main approaches: violence and State terror; military, militarization, and militarism; para-state securitization; and what we submit as “security analytics.” Security analytics moves away from studying security formations, (...) and how much violence or insecurity they yield, to identifying security forms of action, whether or not they are part of the nation-state. As a framework for anthropological inquiry, it is oriented toward capturing how these forms of action work and what types of security they produce. We then illustrate this approach through our fieldwork on counterterrorism in the domains of law enforcement, biomedical research and federal-state counter extremism. In each of our cases, we use security analytics to arrive at a diagnosis of the form of action. The set of conceptual distinctions that we propose as an aid to approaching empirical situations and the study of security is, on another level, a proposal for an approach to anthropology today. We do not expect that the distinctions that aid us will suffice for every situation. Rather, we submit that this work presents a set of specific insights about contemporary U.S. security, and an example of a new approach to anthropological problems. (shrink)

some 20 years. Yet the ethical issues surrounding the disclosure of positive HIV status have not been examined comprehensively. This report examines the ethics behind the disclosure of HIV-positive status primarily or individuals to their sex partners, and for health care practitioners to a patient’s sex partner when the patient is unwilling to disclose. Relevant rights and ethical principles are analysed, including the rights to: self-preservation; privacy and confidentiality; and the bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice. (...) Historic and contemporary individual rights that people living with HIV have regarding disclosure are emphasised, especially in adverse circumstances, where ethics can support non-disclosure based on the right to self-preservation. Rights declarations and current disclosure guidelines for health care practitioners from several international and South African medical organisations also are reviewed. Of key importance to disclosure decisions are the specific situations of individuals in climates rife with stigma toward, and discrimination against, PLHIV, existing more or less worldwide. The potential negative impacts of disclosure are the basis for disclosure decisions of PLHIV. Research study results show that the negative impacts of disclosure can be severe for individuals, ranging from divorce or abandonment to community ostracism and even to murder. Relevant current theories of social justice related to HIV disclosure also are discussed. A conclusion is reached that, by decreasing stigma and discrimination against PLHIV and protecting individual rights related to HIV disclosure, prevention behaviours will be practised more widely, including ‘positive prevention’ by PLHIV and higher rates of disclosure. The eventual result will be the long-term public health goal of decreased spread of HIV. (shrink)

Food Sovereignty is a vibrant discourse in academic and activist circles, yet despite the many shared characteristics between issues surrounding food and public health, the two are often analysed in separate frameworks and the insights from Food Sovereignty are not sufficiently brought to bear on the problems in the public health discourse. In this paper, I will introduce the concept of 'self-organised community viability' as a way to link food and health, and to argue that what I call the 'Health (...) Security' paradigm requires a 'Health Sovereignty' response modelled on Food Sovereignty. (shrink)

W pracy przedstawiono główne założenia polityki zagranicznej George’a W. Busha zaprezentowane w dwóch kampaniach prezydenckich, z 2000 i 2004 roku, opierając się na informacjach pochodzących z transkrypcji debat telewizyjnych. Na podstawie zgromadzonych materiałów autor zaprezentował również ewolucję znacze - nia polityki zagranicznej jako czynnika wpływającego na wynik wyborów, a także zmiany preferencji Amerykanów, które przekładały się na ich poparcie dla poszczególnych kandy - datów na prezydenta. Najpierw wymieniono czynniki, które sprawiają, że polityka zagraniczna staje się wio - dącą kwestią w (...) trakcie kampanii prezydenckich. Opisano także jej specyfikę jako jednego z czynników, na podstawie którego dokonuje się ewaluacji kandydatów. Następnie przy - bliżono zjawisko polegające na tym, że kandydaci często składają obietnice, których nie są w stanie zrealizować i wytłumaczono, dlaczego tak się dzieje. Można zwrócić uwagę na wyraźną ciągłość polityki zagranicznej Stanach Zjednoczonych. Choć kandydaci w trakcie wyborów często proponują zmiany, to jednak tuż po nich jej trzon pozostaje niezmieniony. Autor zaprezentował ewolucję głównych założeń polityki zagranicznej Busha. Podstawę analizy stanowiły wypowiedzi prezydenta zaczerpnięte z debat zarówno z okresu pierw - szej, jak i drugiej kampanii. Pozwoliło to na uchwycenie różnic pomiędzy centralnymi punktami planowanej przez niego aktywności na arenie międzynarodowej, a także zobra - zowanie wyraźnego wzrostu znaczenia wątków związanych z polityką zagraniczną. Autor prześledził przebieg tej zmiany i odszukał jej determinanty. Oprócz odwołań do książek i artykułów naukowych, w publikacji nie zabrakło również wyników sondaży, które zda - niem autora, najlepiej oddawały charakter dokonujących się przemian. (shrink)