Health Equity in a Globalised World: Towards Constraining Global Greed?

“Corporate greed” has recently been denounced in several protest demonstrations in different parts of the world.¹ In those demonstrations, corporations are called to put an end to their being too selfish and greedy for profit and to start caring for the interests of others, especially the many who are poor and unemployed. While such protest movements seem to attract less support in Asian countries than in their Western counterparts,² this does not mean that people there are necessarily indifferent to denouncing “greed”. There is even a familiar quote attributed to Lao Tzu that says that there is no greater disaster than greed (or lavish desires). This may be a different kind of greed than what global protesters are denouncing. But even if people have different conceptions of what should be considered greed and how to denounce it, we could at least agree that we should not only be concerned about our own interests. In certain ways, it may also be beneficial for us to consider how others are faring. For example, we could conceive of the world of being more peaceful and stable if there is less global health inequity as we currently have. Many of the world’s poorest have a life expectancy at birth of less than 50 years in contrast to the global life expectancy at birth of 66.75 years. Ideally, much of the poverty suffered by many in the world could be remedied through ways that will not burden the world’s affluent population. But in the real world, many still avoidably fall below the world’s life expectancy average while theoretical and practical obstacles to motivating effective global action to solve the problem remains. In this article, I explore the plausibility of motivating rich countries to assist poor countries by appealing to the idea of rational constraint: is global resource transfer a rational thing to do from the point of view of any prospective donor? This is done by sketching the implications of David Gauthier’s³ view of rational constraint (to maximising self-interest) to relations between nations. I argue that it is rational for rich countries to transfer a small portion of their wealth for health-targeted assistance to poor countries since: (1) assisting the poor is not burdensome to them; (2) such action is in accordance with the emerging global norms that regulate international relations despite the absence of mechanisms that are expected to enforce such norms; and (3) assisting the poor is the prudent thing to do because it sets the stage for enabling and motivating mutual assistance. Although there are other forms of mutual assistance in the area of defence, infrastructure building, technology transfer, etc., I focus on health-targeted assistance because of the strategic value of establishing enabling conditions for recipients to reciprocate such assistance in the future.

Although duty-based accounts of morally motivating global transfers for the sake of the poor are more common, including accounts of negative duty not to cause harm on others, the duty to compensate for the harm caused on others as part of this negative duty,⁴ I set aside these duty-based accounts to focus on rational advantage as another approach to motivate health-targeted global resource transfers from rich to poor counties. I do this to suggest that Kantian, duty-based reasons for rich countries to assist poor countries are not the only reasons we could use to justify the need to assist the poor. Prudence is another reason for constraining maximisation of rational self-interest. The benefits that arise from engaging in mutual assistance as a rational strategy to promote mutual advantage and reciprocity make it a prudent act. Although rationality of cooperation may seem to appeal only to lower- and middle-income countries, in view of their relative political and economic disadvantage, it should ideally appeal to rich and powerful countries as well since even these countries cannot be sure if they will remain as affluent and as powerful always. Is it not prudent for the rich and powerful to transfer their surplus wealth to assist other countries...