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Published in: BMC International Health and Human Rights 1/2013

Open Access 01-12-2013 | Debate

Cosmopolitanism and foreign policy for health: ethics for and beyond the state

Author: Raphael Lencucha

Published in: BMC International Health and Human Rights | Issue 1/2013

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Abstract

Background

Foreign policy holds great potential to improve the health of a global citizenship. Our contemporary political order is, in part, characterized by sovereign states acting either in opposition or cooperation with other sovereign states. This order is also characterized by transnational efforts to address transnational issues such as those featured so prominently in the area of global health, such as the spread of infectious disease, health worker migration and the movement of health-harming products. These two features of the current order understandably create tension for truly global initiatives.

Discussion

National security has become the dominant ethical frame underlying the health-based foreign policy of many states, despite the transnational nature of many contemporary health challenges. This ethical approach engages global health as a means to achieving national security objectives. Implicit in this ethical frame is the version of humanity that dichotomizes between “us” and “them”. What has been left out of this discourse, for the most part, is the role that foreign policy can play in extending the responsibility of states to protect and promote health of the other, for the sake of the other.

Summary

The principal purpose of this paper is to review arguments for a cosmopolitan ethics of health-based foreign policy. I will argue that health-based foreign policy that is motivated by security interests is lacking both morally and practically to further global health goals. In other words, a cosmopolitan ethic is not only intrinsically superior as a moral ideal, but also has potential to contribute to utilitarian ends. This paper draws on the cosmopolitanism literature to build robust support for foreign policies that contribute to sustainable systems of global health governance.
Literature
1.
go back to reference WHO: World Health Statistics 2011. 2011, Geneva WHO: World Health Statistics 2011. 2011, Geneva
2.
go back to reference Waage J, Banerji R, Campbell O, Chirwa E, Collender G, Dieltiens V, Dorward A, Godfrey-Faussett P, Hanvoravongchai P, Kingdon G: The millennium development goals: a cross-sectoral analysis and principles for goal setting after 2015: lancet and london international development centre commission. Lancet. 2015, 2010 (376): 991-1023. Waage J, Banerji R, Campbell O, Chirwa E, Collender G, Dieltiens V, Dorward A, Godfrey-Faussett P, Hanvoravongchai P, Kingdon G: The millennium development goals: a cross-sectoral analysis and principles for goal setting after 2015: lancet and london international development centre commission. Lancet. 2015, 2010 (376): 991-1023.
3.
go back to reference Schieber GJ, Gottret P, Fleisher LK, Leive AA: Financing global health: mission unaccomplished. Health Aff. 2007, 26: 921-934. 10.1377/hlthaff.26.4.921.CrossRef Schieber GJ, Gottret P, Fleisher LK, Leive AA: Financing global health: mission unaccomplished. Health Aff. 2007, 26: 921-934. 10.1377/hlthaff.26.4.921.CrossRef
4.
go back to reference Beitz C: Cosmopolitanism and global justice. Current Debates in Global Justice. Volume 2. Edited by: Brock G, Moellendorf D. 2005, Netherlands: Springer, 11-27. Studies in Global JusticeCrossRef Beitz C: Cosmopolitanism and global justice. Current Debates in Global Justice. Volume 2. Edited by: Brock G, Moellendorf D. 2005, Netherlands: Springer, 11-27. Studies in Global JusticeCrossRef
5.
go back to reference Kickbusch I, Silberschmidt G, Buss P: Global health diplomacy: the need for new perspectives, strategic approaches and skills in global health. Bull World Health Org. 2007, 85: 230-232. 10.2471/BLT.06.039222.CrossRefPubMedPubMedCentral Kickbusch I, Silberschmidt G, Buss P: Global health diplomacy: the need for new perspectives, strategic approaches and skills in global health. Bull World Health Org. 2007, 85: 230-232. 10.2471/BLT.06.039222.CrossRefPubMedPubMedCentral
6.
go back to reference Drager N, Fidler DP: Foreign policy, trade and health: at the cutting edge of global health diplomacy. Bull World Health Org. 2007, 85: 162-162. 10.2471/BLT.07.041079.CrossRefPubMedPubMedCentral Drager N, Fidler DP: Foreign policy, trade and health: at the cutting edge of global health diplomacy. Bull World Health Org. 2007, 85: 162-162. 10.2471/BLT.07.041079.CrossRefPubMedPubMedCentral
7.
go back to reference Gostin LO, Archer R: The duty of states to assist other states in need: Ethics, human rights, and international law. J Law Med Ethics. 2008, 35: 526-533.CrossRef Gostin LO, Archer R: The duty of states to assist other states in need: Ethics, human rights, and international law. J Law Med Ethics. 2008, 35: 526-533.CrossRef
8.
go back to reference Labonte R, Schrecker T: Foreign policy matters: a normative view of the G8 and population health. Bull World Health Org. 2007, 85: 185-191. 10.2471/BLT.06.037242.CrossRefPubMedPubMedCentral Labonte R, Schrecker T: Foreign policy matters: a normative view of the G8 and population health. Bull World Health Org. 2007, 85: 185-191. 10.2471/BLT.06.037242.CrossRefPubMedPubMedCentral
9.
go back to reference Labonte R, Gagnon ML: Framing health and foreign policy: lessons for global health diplomacy. Globalization Health. 2010, 10.1186/1744-8603-1186-1114. Labonte R, Gagnon ML: Framing health and foreign policy: lessons for global health diplomacy. Globalization Health. 2010, 10.1186/1744-8603-1186-1114.
10.
go back to reference Merchant RM, Leigh JE, Lurie N: Health care volunteers and disaster response — first, Be prepared. N Engl J Med. 2010, 362: 872-873. 10.1056/NEJMp1001737.CrossRefPubMed Merchant RM, Leigh JE, Lurie N: Health care volunteers and disaster response — first, Be prepared. N Engl J Med. 2010, 362: 872-873. 10.1056/NEJMp1001737.CrossRefPubMed
11.
go back to reference Schwartz D: Michaëlle Jean: 'You cannot build a sustainable economy on charity'. 2012, Ottawa: CBC News Schwartz D: Michaëlle Jean: 'You cannot build a sustainable economy on charity'. 2012, Ottawa: CBC News
12.
13.
go back to reference Dowell SF, Tappero JW, Frieden TR: Public health in Haiti — challenges and progress. N Engl J Med. 2011, 364: 300-301. 10.1056/NEJMp1100118.CrossRefPubMed Dowell SF, Tappero JW, Frieden TR: Public health in Haiti — challenges and progress. N Engl J Med. 2011, 364: 300-301. 10.1056/NEJMp1100118.CrossRefPubMed
14.
go back to reference Frist WH: Medicine as a currency for peace through global health diplomacy. Yale Law Policy Rev. 2007, 26: 209-229. Frist WH: Medicine as a currency for peace through global health diplomacy. Yale Law Policy Rev. 2007, 26: 209-229.
15.
go back to reference Feldbaum H, Michaud J: Health diplomacy and the enduring relevance of foreign policy interests. PLoS Med. 2010, 7: e1000226-10.1371/journal.pmed.1000226.CrossRefPubMedPubMedCentral Feldbaum H, Michaud J: Health diplomacy and the enduring relevance of foreign policy interests. PLoS Med. 2010, 7: e1000226-10.1371/journal.pmed.1000226.CrossRefPubMedPubMedCentral
16.
go back to reference Clinton HR: President’s Global Health Initiative. 2009, Washington: Department of State Clinton HR: President’s Global Health Initiative. 2009, Washington: Department of State
17.
go back to reference Kellerhals MD: Obama proposes massive global health initiative. 2009, Washington: US Government Kellerhals MD: Obama proposes massive global health initiative. 2009, Washington: US Government
18.
go back to reference US Department of Health and Human Services: The global health strategy. 2011, Washington US Department of Health and Human Services: The global health strategy. 2011, Washington
19.
go back to reference Aldis W: Health security as a public health concept: a critical analysis. Health Policy Plann. 2008, 23: 369-375. 10.1093/heapol/czn030.CrossRef Aldis W: Health security as a public health concept: a critical analysis. Health Policy Plann. 2008, 23: 369-375. 10.1093/heapol/czn030.CrossRef
20.
go back to reference Katz R, Kornblet S, Arnold G, Lief E, Fischer JE: Defining health diplomacy: changing demands in the Era of globalization. Milbank Q. 2011, 89: 503-523. 10.1111/j.1468-0009.2011.00637.x.CrossRefPubMedPubMedCentral Katz R, Kornblet S, Arnold G, Lief E, Fischer JE: Defining health diplomacy: changing demands in the Era of globalization. Milbank Q. 2011, 89: 503-523. 10.1111/j.1468-0009.2011.00637.x.CrossRefPubMedPubMedCentral
21.
go back to reference Feldbaum H: U.S. Global Health and National Security Policy: A report for the CSIS Global Health Policy Center. 2009, Washington: Center for Strategic and International Studies Feldbaum H: U.S. Global Health and National Security Policy: A report for the CSIS Global Health Policy Center. 2009, Washington: Center for Strategic and International Studies
22.
go back to reference Archibugi D: Cosmopolitan democracy and its critics: a review. Eur J Int Relations. 2004, 10: 437-473. 10.1177/1354066104045543.CrossRef Archibugi D: Cosmopolitan democracy and its critics: a review. Eur J Int Relations. 2004, 10: 437-473. 10.1177/1354066104045543.CrossRef
23.
go back to reference Baker G: Problems in the theorisation of global civil society. Political Studies. 2002, 50: 928-943. 10.1111/1467-9248.00401.CrossRef Baker G: Problems in the theorisation of global civil society. Political Studies. 2002, 50: 928-943. 10.1111/1467-9248.00401.CrossRef
24.
go back to reference Ruger JP: Health, capability, and justice: Toward a new paradigm of health ethics, policy and law. Cornell J Law Pub Policy. 2005, 15: 403-482. Ruger JP: Health, capability, and justice: Toward a new paradigm of health ethics, policy and law. Cornell J Law Pub Policy. 2005, 15: 403-482.
25.
go back to reference Brennan RJ, Waldman RJ: The south Asian earthquake Six months later — an ongoing crisis. N Engl J Med. 2006, 354: 1769-1771. 10.1056/NEJMp068017.CrossRefPubMed Brennan RJ, Waldman RJ: The south Asian earthquake Six months later — an ongoing crisis. N Engl J Med. 2006, 354: 1769-1771. 10.1056/NEJMp068017.CrossRefPubMed
26.
go back to reference Global Health Security Initiative: 10 years of collaborative action. 2011, Brussels: European Commission Global Health Security Initiative: 10 years of collaborative action. 2011, Brussels: European Commission
27.
go back to reference Rubenstein LS: Instruments of peace: The use of health for national security. Harvard Int Rev. 2011, 33: 46-50. Rubenstein LS: Instruments of peace: The use of health for national security. Harvard Int Rev. 2011, 33: 46-50.
28.
go back to reference Tan K-C: Liberal Nationalism and Cosmopolitan Justice. Ethical Theory Moral Prac. 2002, 5: 431-461. 10.1023/A:1021339410934.CrossRef Tan K-C: Liberal Nationalism and Cosmopolitan Justice. Ethical Theory Moral Prac. 2002, 5: 431-461. 10.1023/A:1021339410934.CrossRef
29.
go back to reference Pogge T: World poverty and human rights. Ethics Int Affairs. 2005, 19: 1-7.CrossRef Pogge T: World poverty and human rights. Ethics Int Affairs. 2005, 19: 1-7.CrossRef
30.
go back to reference Gilabert P: The duty to eradicate global poverty: positive or negative?. Ethical Theory Moral Prac. 2005, 7: 537-550. 10.1007/s10677-005-6489-9.CrossRef Gilabert P: The duty to eradicate global poverty: positive or negative?. Ethical Theory Moral Prac. 2005, 7: 537-550. 10.1007/s10677-005-6489-9.CrossRef
31.
go back to reference Miller D: Against global egalitarianism. Current Debates in Global Justice. Volume 2. Edited by: Brock G, Moellendorf D. 2005, Netherlands: Springer, 55-79. Studies in Global JusticeCrossRef Miller D: Against global egalitarianism. Current Debates in Global Justice. Volume 2. Edited by: Brock G, Moellendorf D. 2005, Netherlands: Springer, 55-79. Studies in Global JusticeCrossRef
32.
go back to reference Ruger JP: Global health justice. Pub Health Ethics. 2009, 2: 261-275. 10.1093/phe/php019.CrossRef Ruger JP: Global health justice. Pub Health Ethics. 2009, 2: 261-275. 10.1093/phe/php019.CrossRef
33.
go back to reference Freeman S: Justice and the social contract. 2007, New York: Oxford University Press Freeman S: Justice and the social contract. 2007, New York: Oxford University Press
34.
go back to reference Abizadeh A, Gilabert P: Is there a genuine tension between cosmopolitan egalitarianism and special responsibilities?. Philosophical Studies. 2008, 138: 349-365. 10.1007/s11098-006-9046-z.CrossRef Abizadeh A, Gilabert P: Is there a genuine tension between cosmopolitan egalitarianism and special responsibilities?. Philosophical Studies. 2008, 138: 349-365. 10.1007/s11098-006-9046-z.CrossRef
35.
go back to reference Nussbaum MC: Kant and Stoic Cosmopolitanism. J Politic Philosophy. 1997, 5: 1-25. 10.1111/1467-9760.00021.CrossRef Nussbaum MC: Kant and Stoic Cosmopolitanism. J Politic Philosophy. 1997, 5: 1-25. 10.1111/1467-9760.00021.CrossRef
36.
go back to reference Caney S: Global distributive justice and the state. Political Studies. 2008, 56: 487-518. 10.1111/j.1467-9248.2008.00748.x.CrossRef Caney S: Global distributive justice and the state. Political Studies. 2008, 56: 487-518. 10.1111/j.1467-9248.2008.00748.x.CrossRef
37.
go back to reference Bettcher DW, Yach D, Guindon GE: Global trade and health: key linkages and future challenges. Bull World Health Org. 2000, 78: 521-534.PubMedPubMedCentral Bettcher DW, Yach D, Guindon GE: Global trade and health: key linkages and future challenges. Bull World Health Org. 2000, 78: 521-534.PubMedPubMedCentral
38.
go back to reference Fidler DP: The globalization of public health: the first 100 years of international health diplomacy. Bull World Health Org. 2001, 79: 842-849.PubMedPubMedCentral Fidler DP: The globalization of public health: the first 100 years of international health diplomacy. Bull World Health Org. 2001, 79: 842-849.PubMedPubMedCentral
39.
go back to reference Fidler DP: Health as foreign policy: harnessing globalization for health. Health Promotion Int. 2006, 21: 51-58. 10.1093/heapro/dal051.CrossRef Fidler DP: Health as foreign policy: harnessing globalization for health. Health Promotion Int. 2006, 21: 51-58. 10.1093/heapro/dal051.CrossRef
40.
go back to reference Ruger JP: Health capability: conceptualization and operationalization. Am J Public Health. 2009, 100: 41-49.CrossRef Ruger JP: Health capability: conceptualization and operationalization. Am J Public Health. 2009, 100: 41-49.CrossRef
41.
go back to reference Lencucha R: Philip Morris versus Uruguay: health governance challenged. Lancet. 2010, 376: 852-853. 10.1016/S0140-6736(10)61256-1.CrossRefPubMed Lencucha R: Philip Morris versus Uruguay: health governance challenged. Lancet. 2010, 376: 852-853. 10.1016/S0140-6736(10)61256-1.CrossRefPubMed
42.
go back to reference Fidler DP: Negotiating equitable access to influenza vaccines: global health diplomacy and the controversies surrounding avian influenza H5N1 and pandemic influenza H1N1. PLoS Med. 2010, 7: e1000247-10.1371/journal.pmed.1000247.CrossRefPubMedPubMedCentral Fidler DP: Negotiating equitable access to influenza vaccines: global health diplomacy and the controversies surrounding avian influenza H5N1 and pandemic influenza H1N1. PLoS Med. 2010, 7: e1000247-10.1371/journal.pmed.1000247.CrossRefPubMedPubMedCentral
43.
go back to reference Wendt A: Anarchy is what states make of it: the social construction of power politics. Int Org. 1992, 46: 391-425. 10.1017/S0020818300027764.CrossRef Wendt A: Anarchy is what states make of it: the social construction of power politics. Int Org. 1992, 46: 391-425. 10.1017/S0020818300027764.CrossRef
44.
go back to reference Roemer R, Taylor A, Lariviere J: Origins of the WHO framework convention on tobacco control. Am J Public Health. 2005, 95: 936-938. 10.2105/AJPH.2003.025908.CrossRefPubMedPubMedCentral Roemer R, Taylor A, Lariviere J: Origins of the WHO framework convention on tobacco control. Am J Public Health. 2005, 95: 936-938. 10.2105/AJPH.2003.025908.CrossRefPubMedPubMedCentral
45.
go back to reference Mitchell A, Voon T: Implications of the World Trade Organization in combating non-communicable diseases. Public Health. 2011, 125: 832-839. 10.1016/j.puhe.2011.09.003.CrossRefPubMed Mitchell A, Voon T: Implications of the World Trade Organization in combating non-communicable diseases. Public Health. 2011, 125: 832-839. 10.1016/j.puhe.2011.09.003.CrossRefPubMed
46.
go back to reference Taylor A, Chaloupka FJ, Guindon E, Corbett M: The impact of trade liberalization on tobacco consumption. Tobacco control in developing countries. Edited by: Jha P, Chaloupka FJ. 2000, New York: Oxford University Press Taylor A, Chaloupka FJ, Guindon E, Corbett M: The impact of trade liberalization on tobacco consumption. Tobacco control in developing countries. Edited by: Jha P, Chaloupka FJ. 2000, New York: Oxford University Press
47.
go back to reference McGrady B: Trade and tobacco control: Resolving policy conflicts through impact assessment and administrative type international laws. Asian J World Trade Org Int Health Law Policy. 2008, 3: 341-378. McGrady B: Trade and tobacco control: Resolving policy conflicts through impact assessment and administrative type international laws. Asian J World Trade Org Int Health Law Policy. 2008, 3: 341-378.
48.
go back to reference Held D: Democratic accountability and political effectiveness from a cosmopolitan perspective. Gov Opposition. 2004, 39: 364-391. 10.1111/j.1477-7053.2004.00127.x.CrossRef Held D: Democratic accountability and political effectiveness from a cosmopolitan perspective. Gov Opposition. 2004, 39: 364-391. 10.1111/j.1477-7053.2004.00127.x.CrossRef
49.
go back to reference Held D: Law of states, law of peoples. Legal Theory. 2002, 8: 1-44. 10.1017/S1352325202081016.CrossRef Held D: Law of states, law of peoples. Legal Theory. 2002, 8: 1-44. 10.1017/S1352325202081016.CrossRef
50.
go back to reference Caney S: Cosmopolitan justice and institutional design: An egalitarian liberal conception of global governance. Soc Theory Prac. 2006, 32: 725-756.CrossRef Caney S: Cosmopolitan justice and institutional design: An egalitarian liberal conception of global governance. Soc Theory Prac. 2006, 32: 725-756.CrossRef
51.
go back to reference Brock G: The difference principle, equality of opportunity, and cosmopolitan justice. J Moral Philosophy. 2005, 2: 333-351. 10.1177/1740468105058158.CrossRef Brock G: The difference principle, equality of opportunity, and cosmopolitan justice. J Moral Philosophy. 2005, 2: 333-351. 10.1177/1740468105058158.CrossRef
52.
go back to reference Magnusson RS: Global health governance and the challenge of chronic, Non-communicable disease. J Law Med Ethics. 2010, 38: 490-507. 10.1111/j.1748-720X.2010.00508.x.CrossRefPubMed Magnusson RS: Global health governance and the challenge of chronic, Non-communicable disease. J Law Med Ethics. 2010, 38: 490-507. 10.1111/j.1748-720X.2010.00508.x.CrossRefPubMed
53.
go back to reference Gostin LO: International development assistance for health: Ten priorities for the next president. Hastings Cent Rep. 2008, 38: 10-11.CrossRef Gostin LO: International development assistance for health: Ten priorities for the next president. Hastings Cent Rep. 2008, 38: 10-11.CrossRef
54.
go back to reference Horton R: Health as an instrument of foreign policy. Lancet. 2007, 369: 806-807. 10.1016/S0140-6736(07)60378-X.CrossRefPubMed Horton R: Health as an instrument of foreign policy. Lancet. 2007, 369: 806-807. 10.1016/S0140-6736(07)60378-X.CrossRefPubMed
55.
go back to reference Schrecker T: Denaturalizing scarcity: a strategy of enquiry for public- health ethics. Bull World Health Org. 2008, 86: 600-605. 10.2471/BLT.08.050880.CrossRefPubMedPubMedCentral Schrecker T: Denaturalizing scarcity: a strategy of enquiry for public- health ethics. Bull World Health Org. 2008, 86: 600-605. 10.2471/BLT.08.050880.CrossRefPubMedPubMedCentral
56.
go back to reference Putnam RD: Diplomacy and domestic politics: the logic of two-level games. Int Org. 1988, 42: 427-460. 10.1017/S0020818300027697.CrossRef Putnam RD: Diplomacy and domestic politics: the logic of two-level games. Int Org. 1988, 42: 427-460. 10.1017/S0020818300027697.CrossRef
Metadata
Title
Cosmopolitanism and foreign policy for health: ethics for and beyond the state
Author
Raphael Lencucha
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC International Health and Human Rights / Issue 1/2013
Electronic ISSN: 1472-698X
DOI
https://doi.org/10.1186/1472-698X-13-29

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