Can Resource-Poor Countries Bear any Obligations for Global Distributive Justice?

176 Pages·2016·1 MB·English

Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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Can Resource-Poor Countries Bear any
Obligations for Global Distributive Justice? A
Reflection on the Distribution of Global health
Opportunities

John Barugahare

Dissertation for the degree of philosophiae doctor (PhD)

Department of Philosophy
University of Bergen, Norway
Dissertation date: May 20th 2016

2016
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Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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Table of Contents
Table of Contents ........................................................................................................... 2(cid:3)
List of Tables ................................................................................................................. 7(cid:3)
Acknowledgements ........................................................................................................ 8(cid:3)
(cid:1005)(cid:856) Dedication ........................................................................................................ 10(cid:3)
Abstract ........................................................................................................................ 11(cid:3)
Chapter 1 : Understanding the Context and Challenges in Conceiving
Obligations for Global distributive Justice: The Case of Equity in Health
Opportunities .............................................................................................................. 14(cid:3)
1.0 Introduction ............................................................................................................ 14(cid:3)
Part 1 ............................................................................................................................ 16(cid:3)
1.1 An Overview of Key Issues in Discussions on Global Justice ............................. 16(cid:3)
1. 2 From Global Justice to Global Distributive Justice .............................................. 20(cid:3)
Part II ........................................................................................................................... 22(cid:3)
1.3 Making Sense of Contemporary Debate on Obligations for Global Distributive
Justice ........................................................................................................................... 22(cid:3)
1.3.1 The Controversy .................................................................................................. 23(cid:3)
1.3.1.1 Ideological Influences on views on Global Justice .......................................... 25(cid:3)
1.3.2 Statism-based Theories and Views on Distributive Justice ................................ 25(cid:3)
1.3.2.1 Material Basis of Statist Views on Distributive Justice ................................... 27(cid:3)
1.3.2.2 Implications of Statist Claims about the scope of Distributive Justice ............ 29(cid:3)
1. 3.3 Cosmopolitanism and Requirements of Distributive Justice ............................. 31(cid:3)
1.3.3.1 Cosmopolitanism’s claims about the scope of justice ...................................... 32(cid:3)
1.3.3.2 Implications of Cosmopolitanism in Relation to Statism ................................. 34(cid:3)
1.3.4 Whether Statist Views on the scope of Distributive Justice are Consistent in the
Current Global Realities .............................................................................................. 36(cid:3)
1.3.4.1 What is the Relevant Nature of Association that Justifies the Application of
Robust Principles of Distributive Justice? ................................................................... 37(cid:3)
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Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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1.3.4.2 Whether ‘Globalisation’ Entails a ‘Global Association’ ................................. 38(cid:3)
1.3.4.3 Historical evidence of Global Cooperation and Coercion .............................. 43(cid:3)
1.3.4.4 General Position from the Analysis ................................................................. 44(cid:3)
1.3.4.5 Potential Objection .......................................................................................... 44(cid:3)
1.3.4.6 Summary of the Debate .................................................................................... 46(cid:3)
1.3.5 Gaps in the Debate and the Way Forward .......................................................... 47(cid:3)
Part III .......................................................................................................................... 49(cid:3)
1.4 Conceptual Analysis and Scope of the Discussion ................................................ 49(cid:3)
1.4.1 ‘Justice’ and ‘Distributive Justice’ ...................................................................... 49(cid:3)
1.4.2 ‘Global Justice’ and ‘Global Distributive Justice’ .............................................. 51(cid:3)
1.4.3 ‘Obligations of Justice’ and ‘Duties of Humanity’ ............................................. 51(cid:3)
1.4.4 Global ‘Inequalities’ and ‘Inequities’ in Relation to the Global Justice Agenda 53(cid:3)
1.4.5 ‘Global Justice’, ‘Global Egalitarianism’ and the “Minimal Conception of
Justice” ......................................................................................................................... 54(cid:3)
1.4.6 Achieving the Global Minimum Fairly ............................................................... 55(cid:3)
Part IV .......................................................................................................................... 57(cid:3)
1.5 Leanings in Discussions and Actions on Justice in Global Health ........................ 57(cid:3)
1.5.1 What Does Justice in Global Health Require? .................................................... 58(cid:3)
1.5.2 Obligations of National Governments towards Global Health Justice ............... 59(cid:3)
1.5.3 Source of Concern about Justice in Global health .............................................. 61(cid:3)
1.5.3.1 Disproportionate Distribution of Global Health Resources ............................ 62(cid:3)
1.5.4 Contemporary Responses to Injustice in Global Health ..................................... 64(cid:3)
1.5.4.1 Proposals and Actions against Inequitable Distribution of Health
Opportunities ............................................................................................................... 65(cid:3)
1.5.4.2 Towards Equity in Global Health Financing ................................................... 67(cid:3)
1.5.5 Health Financing among LICs and the Possibility of Equity in Global Health
Financing ...................................................................................................................... 68(cid:3)
1.5.5.1 Inequities in Health Financing within and between Countries ....................... 69(cid:3)
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Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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1.5.5.2 How Does PHE Impact on Equity Within Countries? ..................................... 72(cid:3)
1.5.5.3 Inequity between Developing Countries .......................................................... 74(cid:3)
1.5.6 Summary ............................................................................................................. 76(cid:3)
1.5.7 The Way Forward with Global Justice in Health ................................................ 76(cid:3)
Chapter2 : Understanding the futility of countries’ obligations for health rights:
realising justice for the global poor .......................................................................... 78(cid:3)
Introduction .................................................................................................................. 78(cid:3)
Abstract ........................................................................................................................ 81(cid:3)
Background .................................................................................................................. 82(cid:3)
Preliminaries ................................................................................................................ 84(cid:3)
Discussion .................................................................................................................... 85(cid:3)
Reasons forthe futility of current obligations .............................................................. 86(cid:3)
Superficial reasons for the futility of current obligations ............................................ 86(cid:3)
Fundamental reasons for the futility of obligations for global distributive justice ..... 94(cid:3)
The way forward .......................................................................................................... 98(cid:3)
Conclusion ................................................................................................................. 102(cid:3)
Endnotes ..................................................................................................................... 103(cid:3)
List of Abbreviations ................................................................................................. 104(cid:3)
Competing interests ................................................................................................... 104(cid:3)
Acknowledgments ...................................................................................................... 104(cid:3)
Authors Contributions ................................................................................................ 104(cid:3)
Authors’ information ................................................................................................. 104(cid:3)
References .................................................................................................................. 105(cid:3)
Chapter 3 : Obligations of low income countries to facilitate the achievement of
global distributive justice ........................................................................................ 107(cid:3)
Obligations of Poor Countries in Ensuring Global Justice: The Case of Uganda ..... 109(cid:3)
Introduction and Background .................................................................................... 109(cid:3)
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Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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The On Going Debate ................................................................................................ 110(cid:3)
Poor Countries’ Obligations Relating to International Justice .................................. 113(cid:3)
Poor Countries, Armed Aggression and Global Justice ............................................. 114(cid:3)
The Uganda-Democratic Republic of Congo Case .................................................... 114(cid:3)
Obligation Pertaining to Aid ...................................................................................... 116(cid:3)
Obligation ofEffective Management of Aid .............................................................. 118(cid:3)
Contributory Negligence and the Duty of Due Diligence ......................................... 119(cid:3)
The Principle of Contributory Negligence ................................................................. 119(cid:3)
Extrapolating the Principle into Global Justice Debate ............................................. 120(cid:3)
Should Poor Countries Bear Duties of Due Diligence? ............................................. 121(cid:3)
Some Potentially Persistent Challenges ..................................................................... 124(cid:3)
Conclusion ................................................................................................................. 125(cid:3)
Literature .................................................................................................................... 126(cid:3)
Chapter 4 : Implementing Low Income Country Obligations: an illustrative case
from global health financing ................................................................................... 130(cid:3)
Obligations of low income countries in ensuring equity in global health
financing .................................................................................................................... 132(cid:3)
Discussion .................................................................................................................. 138(cid:3)
LICs’ minimum financial obligation for health ......................................................... 138(cid:3)
A mechanism for achieving equitable burden-sharing in global health financing .... 139(cid:3)
Some preliminary points ............................................................................................ 141(cid:3)
LICs’ financing obligation and intra-LIC equity ....................................................... 148(cid:3)
Potential controversies .............................................................................................. 151(cid:3)
Conclusion ................................................................................................................. 152(cid:3)
Chapter 5 .................................................................................................................... 158(cid:3)
General Conclusion .................................................................................................... 158(cid:3)
5.1 General Claim and Nature of Reasoning ............................................................. 158(cid:3)
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Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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5.2 Nature and Scope of Discussion .......................................................................... 159(cid:3)
5.3 Issues in Debates on General Obligations for Global Distributive Justice .......... 160(cid:3)
5.4 Major Concern ..................................................................................................... 162(cid:3)
5.5 The case of Global Health Equity ........................................................................ 164(cid:3)
5.6 Further Remarks and Recommendations for Further Enquiry ............................. 166(cid:3)
5.6.1 Going beyond the Hypothetical ........................................................................ 166(cid:3)
5.6.2 Obligations beyond Health Resource Contributions ........................................ 168(cid:3)
References .................................................................................................................. 169(cid:3)
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Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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List of Tables
Table 1: Health Financing in WHO Africa Region, 2010(cid:3)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:3)(cid:1011)(cid:1004)(cid:3)
Table 2: Inequitable health financing due to unequal budget allocations to health
between Uganda and Kenya(cid:3)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:3)(cid:1005)(cid:1008)(cid:1006)(cid:3)
Table 3: The effect of standardising financing obligation at Abuja’s 15% on inter-
country financing equity(cid:3)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:856)(cid:3)(cid:1005)(cid:1008)(cid:1008)(cid:3)
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Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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Acknowledgements
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In the first place I wish to thank the Norwegian Government for the financial support
through its Quota Scheme from which I benefited twice – for both my Master of
Philosophy and PhD studies. I also thank the administration of the Institute of
Philosophy University of Bergen for accepting me in both of these programs and the
support they rendered me which made it possible for me to benefit from the above
scheme and at the same time made it easy for me to successfully complete my studies.
In Particular I am grateful to Institute Leader Pro. Reidar K. Lie for the administrative
support he enabled me to get from the institute. I also wish to thank Kirsten Bang,
administrative research coordinator of the Institute of Philosophy at the University of
Bergen, for her assistance during the preparation process for submission of the thesis.
I am also very grateful to the administration at the Division of Student Affairs,
particularly Ms Ana Veronica Cordova for her great support with great patience and
kindness.
In second regard I wish to express my special and most sincere thanks to my mother
M.G. Korukanga for the rare sacrifices she made to see me though school. For the
same kind of support I cannot forget the kindness of the following; Mr.
KatsigaireSavino, Prof. John Ntambirweki and Senior QC Jeffrey
KandeebeNtambirweki. To Kankunda Mary, I wish express my recognition of your
moral support and patience with me for the very long time I stayed away from home
while on this program. I cannot thank you enough.
Lastly and most important of all, I would like to thank my doctoral supervisor,
Professor Reidar K. Lie, for his encouragement, guidance and all help he rendered me
in the course of my PhD program. It has been a great privilege to be his student both
at my Master’s and PhD level. It was due to his guidance and encouragement that I
was able to apply philosophical reasoning into practical issues of health, particularly
reasoning about what it may take to achieve or move close to justice in the
distribution of health opportunities both at national and global levels. I am grateful for
the trust he reposed in me when I asked him to allow attempt write my PhD thesis by
publication – a route that is less common in philosophy and the humanities in general.
I thank him for allowing me acquire the crucial experience of what it takes to get a
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Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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non-empirical manuscript acceptance for publication. This is the greatest skill I have
learnt from him. His timely, constructive and critical comments made with utmost
politeness gave encouragement that enable me achieve this end. I cannot thank him
enough.
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Can Resource-Poor Countries Bear any Obligations for Global Distributiv(cid:3)e Justice? A Reflection on the Distribution of Global
health Opportunities
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Dedication
To Maria Gorret K. Katabaazi&Kankunda Mary
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