Global Health Impact: Sustainable Healthcare in Practice.

The third chapter presents the book’s new proposal for addressing the access to medicines problem. It suggests that by collecting and analyzing data on global health, people can come up with new ways to improve poor people’s access to essential drugs and technologies. It suggests utilizing information about medicines’ global health impact (organized by drug, disease, country, and company) to create incentives for positive change. One possibility is to give pharmaceutical companies with the most impactful drugs a Global Health Impact label to use on all their products. Highly rated companies will have an incentive to use the label to get a larger share of the market. Further, socially responsible investment companies could include Global Health Impact companies in their portfolios. Finally, having a Global Health Impact certification system for pharmaceutical companies would open the door to all kinds of fruitful social activism. One possibility is a Global Health Impact licensing campaign. Pharmaceutical companies rely, to a large extent, on university research and development. So, if universities allow only certified companies to benefit from their technology, companies will have an incentive to abide by Global Health Impact standards.

Many people around the world cannot access essential medicines for diseases like malaria, tuberculosis (TB) and HIV/AIDS. One way of addressing this problem is a Global Health Impact certification system where pharmaceutical companies are rated on the basis of their drugs’ impact on global health. The best companies, in a given year, will then be allowed to use a Global Health Impact label on all of their products – everything from lip balm to food supplements. Highly rated companies will have an incentive to use the label to garner a larger share of the market. If even a small percentage of consumers promote global health by purchasing Global Health Impact products, the incentive to use this label will be substantial. An associated Global Health Impact licensing campaign will also have a big impact. Pharmaceutical companies rely, to a large extent, on university research and development. So, if universities only allow companies that agree to use Global Health Impact practices to benefit from their technology, companies will have an incentive to abide by Global Health Impact standards. The Global Health Impact certification system gives companies a reason to produce medicines that will save millions of lives (like a new malaria or HIV vaccine). This paper presents a model rating system that can provide the basis for Global Health Impact certification. It explores some of the methodological choices underlying the construction of this index and explains how the model can be improved with further research.

How should we measure medicines’ global health impact to set targets, monitor performance and improve health around the world? Can such a metric provide a philosophically well-grounded basis for an ethical consumption campaign that will create incentives for pharmaceutical companies and other agents to expand (equitable) access to essential medicines? And if such metrics exist, how should we think about our individual obligations to support ethical consumption campaigns on this basis? This paper reflects on these questions in light of Tim Campbell’s, Yukiko Asada’s, and Andreas Albertsen’s worries about the answers I provide in Global Health Impact: Extending Access on Essential Medicines. I explain how reflecting on treatments consequences for individuals’ ability to live minimally well supports the creation of the Global Health Impact (GHI) index (https://global-health-impact.org/). I also consider how the index might be modified to better support efforts to promote everyone’s human rights. Finally, I argue that individuals should often promote positive change through GHI and other ethical consumption campaigns.

The negative global health impacts (GHIs) associated with the consumption of farmed animal products are wide-ranging and morally significant. This paper considers four options that policy-makers might adopt to curtail the negative GHIs associated with the consumption of farmed animal products. These options are: 1. to introduce a ban on the consumption of farmed animal products; 2. to increase the costs of farmed animal products; 3. to educate people about the negative GHIs associated with the consumption of farmed animal products; and 4. to introduce a qualified ban on the consumption of farmed animal products. I argue that the fourth option is the most effective and, provided that policy-makers think that the negative GHIs associated with the consumption of farmed animal products are sufficiently great and that a total ban would be unfair, it is the political strategy that must be preferred over the available alternatives.

If Global Health Impact labeling is successful, it will give companies a reason to produce drugs that will save millions of lives. One might wonder, however, whether consumers have any moral obligation to purchase goods from Global Health Impact–certified companies or whether purchasing these goods is even morally permissible. The fourth chapter suggests that, if the proposal is implemented, there is reason to purchase goods from Global Health Impact–certified companies. It defends something along the lines of this argument: (1) pharmaceutical companies violate rights and (2) do not do enough to address the access to medicines issue, so (3) if the Global Health Impact initiative helps rectify these problems, people should generally purchase goods from certified companies.

BackgroundThe UK government committed to undertaking impact assessments of its policies on the health of populations in low and middle-income countries in its cross-government strategy “Health is Global”. To facilitate this process, the Department of Health, in collaboration with the National Heart Forum, initiated a project to pilot the use of a global health impact assessment guidance framework and toolkit for policy-makers. This paper aims to stimulate debate about the desirability and feasibility of global health impact assessments by describing and drawing lessons from the first stage of the project.DiscussionDespite the attraction of being able to assess and address potential global health impacts of policies, there is a dearth of existing information and experience. A literature review was followed by discussions with policy-makers and an online survey about potential barriers, preferred support mechanisms and potential policies on which to pilot the toolkit. Although policy-makers were willing to engage in hypothetical discussions about the methodology, difficulties in identifying potential pilots suggest a wider problem in encouraging take up without legislative imperatives. This is reinforced by the findings of the survey that barriers to uptake included lack of time, resources and expertise. We identified three lessons for future efforts to mainstream global health impact assessments: 1) Identify a lead government department and champion – to some extent, this role was fulfilled by the Department of Health, however, it lacked a high-level cross-government mechanism to support implementation. 2) Ensure adequate resources and consider embedding the goals and principles of global health impact assessments into existing processes to maximise those resources. 3) Develop an effective delivery mechanism involving both state actors, and non-state actors who can ensure a “voice” for constituencies who are affected by government policies and also provide the “demand” for the assessments.SummaryThis paper uses the initial stages of a study on global health impact assessments to pose the wider question of incentives for policy-makers to improve global health. It highlights three lessons for successful development and implementation of global health impact assessments in relation to stewardship, resources, and delivery mechanisms.

In this paper, I raise some doubts about Nicole Hassoun's account of the obligations of states, pharmaceutical firms, and consumers with regard to global health, presented in Global Health Impact. I argue that it is not necessarily the case, as Hassoun claims, that if states are just, and therefore satisfy all of their obligations, then consumers will not have strong moral reasons, and perhaps obligations, to make consumption choices that are informed by principles and requirements of justice. This is because there may be justice-based limits on what states can permissibly and feasibly do both to promote access to existing drugs for all of those who need them, and to promote research and development for new drugs that could treat diseases that primarily affect the global poor. One important upshot of my argument is that there can be reasons for organizations like the Global Health Impact Organization to exist, and to do the kind of work that Hassoun argues is potentially valuable in our deeply unjust world, even in much less unjust worlds in which states and firms largely, or even entirely, comply with their obligations.

Background: Ayurveda, the traditional Indian system of medicine, emphasizes harmony between human health and the environment. Its preventive and holistic approach naturally integrates sustainable practices beneficial for both individual and planetary well-being. Objective: To highlight how Ayurveda principles, support environmental sustainability and contribute to global health. Methods: A thematic analysis of Ayurveda concepts diet, lifestyle, herbal medicine and resource use was conducted to assess their relevance to sustainability and global health promotion. Results: Environmental Sustainability: Ethical harvesting of medicinal plants, biodiversity preservation, minimal waste therapies, and eco-friendly resource management. • Global Health Impact: Preventive care through daily and seasonal routines, management of lifestyle disorders, promotion of mental well-being, and cost-effective complementary healthcare. • Alignment with SDGs: Supports Good Health (SDG 3), Responsible Consumption (SDG 12), Climate Action (SDG 13) and Life on Land (SDG 15). Conclusion: Ayurveda offers a viable model for sustainable healthcare by integrating preventive health strategies with ecological balance, contributing to both individual well-being and global environmental goals.

ISEE-0925 Abstract: Development of energy policies that improve global health requires understanding the complex interplay between systems for energy delivery and a sustainable, healthy environment. The growing health risks associated with greenhouse gas emissions has resulted in a global call for development of new energy policies emphasizing efficiency and low-carbon energy cycles; yet increased access to affordable and stable energy are important considerations for improving health in developing nations. Development of a comprehensive framework for assessing the global health implications of energy systems will allow policymakers to compare health impacts across proposed energy policies. Using a life cycle approach, a framework is developed that examines potential routes to health impacts from each stage of the energy production process. Taking coal-fired power generation as an example, the health impacts that are of particular concern are occupational hazards in the coal mining industry (including accidents, pneumoconiosis, COPD, and noise induced hearing loss), and public health impacts attributable to emissions of nitrous oxides, sulfur oxides, particulate matter, heavy metals, and greenhouse gases. Dioxin and radionuclide emissions may be of concern as well. Each of these categories are considered in detail, focusing on comparative risk assessment approaches developed by the World Health Organization to estimate the global disease burden associated with individual risk factors. This project can serve as a framework to develop similar assessments for alternative energy systems, thereby allowing global health impact comparisons across power generation technologies.

Partly in response to rising rates of obesity, many governments have published healthy eating advice. Focusing on health advice related to the consumption of animal products (APs), I argue that the individualistic paradigm that prevails must be replaced by a radically new approach that emphasizes the duty of all human beings to restrict their negative "Global Health Impacts" (GHIs). If they take human rights seriously, many governments from nations with relatively large negative GHIs-including the Australian example provided here-must develop strategies to reduce their citizens' negative GHIs. As the negative GHIs associated with the consumption of many APs are excessive, it is my view that many governments ought to adopt a qualified ban on the consumption of APs.

Should people have a legal human right to health? And, if so, what exactly does protecting this right require? This essay defends some answers to these questions recently articulated in Global Health Impact. It explains how these answers depend on a particular way of thinking about health and the minimally good life, how quality of life matters at and over time, what various agents should do to help people who are unable to live well enough, and many other things. Moreover, it suggests some ways of improving common metrics for measuring and advancing our collective global health impact.

In a previous work, I argued that all human beings should possess the right to adequate health protection and that we have good reasons to believe that not all human beings are or will be able to enjoy this right. I introduced the ‘Global Health Impact’ or ‘GHI’ concept as a unit of measurement to evaluate the effects of human actions on the health of human and nonhuman organisms and argued that the negative GHIs produced by our current generation jeopardise the right to adequate health protection of future generations unjustifiably. In this article, this incomplete theory of human justice is applied to the negative GHIs associated with the consumption of farmed animal products. Since the negative GHIs of such products generally exceed those associated with other diets, I argue that those who exceed their fair share of negative GHIs might curtail their consumption and that the costs of reducing negative GHIs in this domain might be lower than the costs associated with other things that could be done to reduce negative GHIs.

There are many multi-attribute indicators of countries’ levels of wealth, poverty, inequality, and development. Some of these indicators, such as the Human Development Index, consider aspects of population health. This chapter presents the first multi-attribute indicator comparing the impact of key drugs on poor health across the world: the Global Health Impact (GHI) index. It evaluates the impact of key drugs on malaria, tuberculosis, HIV/AIDS, and several neglected tropical diseases in every country in the world. The chapter includes a discussion of possible future directions for research and ends with a discussion of the GHI index and numerous questions that remain regarding its methodology and implementation.

We are in the midst of a crisis of climate change and environmental degradation that will only get worse, unless significant changes are rapidly made. Globally, the healthcare sector causes a large share of our total environmental footprint: 4.4% of greenhouse gases. Sustainable healthcare has emerged as a way for healthcare sectors in high‐income countries to help mitigate climate change by reducing their emissions. Whether global health should be sustainable and what ethical grounds might exist to support such a claim are not questions that have been investigated. The paper argues that global health practice—the delivery of health services to underserved populations in resource‐poor areas of the world—should be sustainable as a matter of climate justice and solidarity. Reducing climate change‐related risks and harms for the vulnerable is integral to the mission of global health and thus it is necessary to consider the climate impact of its practice. The field has a duty to provide sustainable health services that are responsive to climate change‐related changes in the local burden of disease and to build sustainable health system infrastructure. Specific responsibilities for global health funders, managers, and implementers to uphold the duty are proposed. To conclude, the paper considers what limits might be placed on the duty to deliver sustainable global healthcare.

A new role for anaesthetists in environmentally-sustainable healthcare.