Inequality, world health, and global governance

Abstract

Richard Horton1Horton R Offline: Rosa Luxemburg and the struggle for health.Lancet. 2019; 393: 114Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar correctly states that good health depends on political, economic, and social forces that shape conditions of living. To address health care on a global scale, immediate and comprehensive efforts both on an international and national level have to be realised. The most imminent and relevant global issue that is closely linked to world health is probably climate change.2Watts N Amann M Arnell N et al.The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come.Lancet. 2018; 392: 2479-2514Summary Full Text Full Text PDF PubMed Scopus (439) Google Scholar Climate change has direct negative local effects (eg, droughts, flooding, and famine) and supraregional repercussions (eg, migration). Although the biggest portion of medical resources is allocated to the so-called developed world, most of the affected people live in low-income and middle-income regions.3Meyer S Willhelm C Girisch W Gottschling S Gräber S Gortner L The role of developing countries in generating Cochrane meta-analyses in the field of pediatrics (neonatology and neuropediatrics): a systematic analysis.World Health Popul. 2013; 14: 24-32Crossref PubMed Scopus (6) Google Scholar Important results have materialised from global collaboration on this issue (eg, the Paris climate agreement). However, to achieve sustainable solutions, the concept of global governance—ie, Weltinnenpolitik, a term first coined by Carl Friedrich von Weizsäcker—will have to be implemented.4Bartosch U Gansczyk K Weltinnenpolitik für das 21. Jahrhundert verpflichtet. Carl-Friedrich von Weizäcker [In German].Weltinnenpolitische Colloquien Bd. 1. LIT-Verlag, Berlin2009Google Scholar This concept, which builds on the role of multilateralism and strong international institutions, has been under constant attack since its first introduction, and this criticism has only been intensified by current statesmen and stateswomen favouring nationalism over international collaboration. Furthermore, inequality in wealth does not only exist between different countries, but also within countries, leading to widened inequalities with regard to life expectancy and to stunted life expectancy gains in the economically most deprived regions.5Bennett JE Pearson-Stuttard J Kontis V Capewell S Wolfe I Ezzati M Contributions of diseases and injuries to widening life expectancy inequalities in England from 2001 to 2016: a population-based analysis of vital registration data.Lancet Public Health. 2018; 3: e586-e597Summary Full Text Full Text PDF PubMed Scopus (64) Google Scholar Notably, “while there may be underlying economic forces at play, politics have shaped the market, and shaped it in ways that advantage the top at the expense of the rest“6Stiglitz JE The price of inequality: how today's divided society endangers our future. W W Norton & Company, New York2012Google Scholar—with both financial and subsequent health-related consequences. Unequal distribution of wealth will be a constant stimulus to populistic, right-wing movements as seen throughout many countries in Europe. These movements have a strong tendency to promote myopic, national solutions, rather than tackling problems of inequality on both a national and international scale. Although political internationalism (built on close cooperation of nations worldwide) aims to achieve better equality between and within countries and differs substantially from the political concept endorsed by Rosa Luxemburg, it has the potential to provide sustainable solutions to the most important and relevant health issues. Moreover, successful and fair redistribution of wealth has the potential to reign in centrifugal, nationalistic tendencies. In doing so, a fair, democratic, and still competitive political process is promoted, thus providing the basis for improving the quality of health and life around the globe—an aim that Rosa Luxemburg would have fully subscribed to. I declare no competing interests. Offline: Rosa Luxemburg and the struggle for healthOn Jan 15, 1919, amid the beginnings of a revolution in post-World-War I Germany, Rosa Luxemburg, a Polish economist and leader of Germany's radical left, was executed in Berlin by militia acting on behalf of the governing Social Democratic Party. She was 47 years old. Her body, loaded with weights, was flung into a nearby canal. Luxemburg has become a legendary figure, although more admired as a martyr than studied as an intellectual. She was an anti-war activist, campaigned for women's emancipation, and opposed Russia's brutal suppression of freedom and democracy. Full-Text PDF