O'Neill Institute Papers

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This article deals with a foreign policy question of extraordinary importance: What responsibilities do States have to provide economic and technical assistance to other states that have high levels of need affecting the health and life of their citizens? The question is important for a variety of reasons. There exist massive inequalities in health globally, with the result that poorer countries shoulder a disproportionate burden of disease and premature death. While poor countries have by far the greatest ongoing health needs, they also have the least capacity to meet those needs. In addition to the pervasive and debilitating effects of endemic disease, developing countries are likely to suffer much more from the effects of acute health hazards, ranging from natural disasters and dislocations to emerging infectious diseases.

Certainly, governments and philanthropic organizations have responded to highly visible natural disasters, droughts, and famines—at least while the issue remains salient in the media. And there has been increased international assistance for high-profile health threats such as AIDS and pandemic influenza. Even factoring in these new investments, most OECD countries have not come close to fulfilling their pledges to donate 0.7% of Gross National Income per annum.

The question then arises, if states have the capacity to assist less developed states (while continuing to fulfill their obligations to the health of their own citizens) to what extent do they have a well-defined legal or ethical responsibility to do so? We claim that States have a responsibility to help, derived from international law, political commitments, ethical values, and national interest. However, international law does not enable states to operationalize this responsibility in specific cases and in a transparent manner. As a result, transnational cooperation by states tends to be ineffectual and inconsistent—although states can and sometimes do act effectively when ethical and legal responsibilities and commitments align with self-interest.