Trade, foreign policy, diplomacy and health


The Constitution of WHO (1946) states that good health is a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity. Health is a resource for everyday life, not the object of living, and is a positive concept emphasizing social and personal resources as well as physical capabilities. Health is a fundamental human right, recognized in the Universal Declaration of Human Rights (1948). It is also an essential component of development, vital to a nation's economic growth and internal stability. Along with the traditional and unequivocal arguments on social justice and the importance of health, it is now accepted that better health outcomes play a crucial role in reducing poverty. There is also increased understanding of how health fits into a wider cross-sectoral, cross-border and globalized framework. Four key values guide efforts to address health issues:

  • Recognition of the universal right to health
  • Continued application of health ethics to policy, research and service provision
  • Implementation of equity orientated policies and strategies that emphasize solidarity
  • Incorporation of a gender perspective into health policies.

Health ethics involves a process of systematic and continuous reflection on the norms and values which should guide decisions about health care at the personal, institutional, or societal level, and by which the outcomes of such decisions may be judged.

Moral reasoning involves pursuing rules, principles, and theories. Moral rules state that actions of a certain kind ought (or ought not) to be done because they are right (or wrong). These rules are justified by basic and independent principles such as justice (fairness), respect for persons, beneficence, and parsimony (efficient use of resources). These principles reflect comprehensive ethical theories, such as utilitarianism (in which the rightness of a choice depends on whether it maximizes the good) and deontology (in which actions are judged according to their adherence to fundamental duties). Compared to medical ethics, which focuses on individuals, health ethics also encompasses the full range of health determinants and their interconnections, viewed from a societal or systems perspective.

A health determinant is a force or element that affects health, either positively or negatively. Health is determined by both intrinsic forces, such as genetics, behaviour, culture, habits and lifestyles, and extrinsic forces such as preventative, curative and promotional aspects of the health sector, as well as elements outside the health sector including:

  • Economic factors, such as trade
  • Social factors, such as poverty
  • Environmental factors, such as climate change
  • Technological factors, such as information technology.

Global health refers to widespread health impacts that affect large numbers of people across boundaries of geography, time and culture. It includes the impacts on the global ecosystem and other health determinants, such as poverty and genetics. Global health implies a context that includes the whole world and produces its own institutional complexities.

Recently, a clear recognition has emerged that the solution to many health problems lies in addressing their root causes (health determinants), many of which are outside the direct control of the health sector. This means it is necessary to integrate effective health dimensions into other sectors such as agriculture, transport and housing, in what are called cross-sectoral policies. For example, poor housing, inadequate and unsafe water, and pollution all expose people to health risks. This requires new levels of cooperation between health and various other development sectors. However, cross-ministry and multi-donor coordination is particularly difficult in countries that are poor and when ministries lack resources to fulfil their mandate.